Organization
QLIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY JEROME BLALOCK JR. (CEO)
(757) 770-8214
Entity
Organization
Contact information
Practice address
20313 SHEFFIELD PL, SOUTH CHESTERFIELD, VA 23803-1637
(757) 687-9236
Mailing address
20313 SHEFFIELD PL, SOUTH CHESTERFIELD, VA 23803-1637
(757) 687-9236
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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