Organization
GRANDSLAM RESIDENTIAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW DAVIS (CEO)
(804) 691-9178
Entity
Organization
Contact information
Practice address
14012 ROCKHAVEN DR, CHESTER, VA 23836-9721
(804) 691-9178
Mailing address
14012 ROCKHAVEN DR, CHESTER, VA 23836-9721
(804) 691-9178
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2194
VA
Other
Enumeration date
01/26/2014
Last updated
01/26/2014
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