Organization
TEEN OPTION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. A JOHN BAMISILE (CEO)
(804) 745-8070
Entity
Organization
Contact information
Practice address
6721 GILLS GATE CT, CHESTERFIELD, VA 23832-6005
(804) 745-8070
(804) 745-7554
Mailing address
6432 ELKHARDT RD, RICHMOND, VA 23225-7819
(804) 745-8070
(804) 745-7554
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
1528-14-001
VA
320800000X
Mental Illness Community Based Residential Treatment Facility
1528-14-002
VA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
1528-14-001
VA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
1528-14-002
VA
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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