Organization
MENTAL WELLNESS RESIDENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIE B UDOFIA (CEO)
(919) 697-7991
Entity
Organization
Contact information
Practice address
1420 SPRUCE STREET EXTRENSION, MARTINSVILLE, VA 24412
(276) 790-3473
(276) 632-2010
Mailing address
PO BOX 3628, MARTINSVILLE, VA 24115-3628
(919) 697-7991
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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