Organization
SOUTHSIDE GROUP HOMES, LLC
Active
Organization
SOUTHSIDE GROUP HOMES, LLC
Active
Other names
Southside Group Homes
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANN ILAPIT (OWNER)
(757) 362-1479
Entity
Organization
Contact information
Practice address
3400 AIRLINE BLVD, PORTSMOUTH, VA 23701-2623
(757) 673-1483
Mailing address
3400 AIRLINE BLVD, PORTSMOUTH, VA 23701-2623
(757) 673-1483
(757) 405-6326
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173726701
—
VA
05
—
0243633416
—
VA
05
—
0610652114
—
VA
05
—
0730265045
—
VA
Enumeration date
04/25/2019
Last updated
04/25/2019
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