Organization
GRAND ANNE RESIDENCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH Z SHAFER QRMP (EXECUTIVE DIRECTOR)
(540) 261-2222
Entity
Organization
Contact information
Practice address
2104 WALNUT AVE, BUENA VISTA, VA 24416-2738
(540) 261-2222
(540) 261-2222
Mailing address
2104 WALNUT AVE, BUENA VISTA, VA 24416-2738
(540) 261-2222
(540) 261-2222
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1952
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952
DBHDS
VA
Enumeration date
02/18/2013
Last updated
02/18/2013
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