Organization
DOMINION LIFESTYLE SERIVCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNN TURNER SIVELS (EXECUTIVE DIRECTOR / OWNER)
(703) 753-2503
Entity
Organization
Contact information
Practice address
5368 MORTONS FORD WAY, HAYMARKET, VA 20169-4520
(703) 753-2503
Mailing address
5368 MORTONS FORD WAY, HAYMARKET, VA 20169-4520
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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