Organization
SEEDS OF CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AARON BERNARD RUSSELL JR. (EXECUTIVE OFFICER)
(757) 647-2407
Entity
Organization
Contact information
Practice address
2015 LIVERPOOL ST, PORTSMOUTH, VA 23704-3049
(757) 606-3284
(757) 606-3284
Mailing address
2015 LIVERPOOL ST, PORTSMOUTH, VA 23704-3049
(757) 606-3284
(757) 606-3284
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1078-014-001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
KAR1112
—
VA
Enumeration date
04/27/2009
Last updated
04/27/2009
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