Organization
412 RESIDENTIAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ZAIRE CARTER (PROGRAM DIRECTOR)
(804) 248-0375
Entity
Organization
Contact information
Practice address
3807 CANNINGTON DR, NORTH CHESTERFIELD, VA 23237-1968
(804) 248-0375
Mailing address
3807 CANNINGTON DR, NORTH CHESTERFIELD, VA 23237-1968
(804) 248-0375
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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