Organization
LA MARIPOSA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN LOUISE CARLISLE (CVO)
(757) 403-0429
Entity
Organization
Contact information
Practice address
3568 KARLIN AVE, NORFOLK, VA 23502-3111
(757) 466-9999
(757) 466-9966
Mailing address
475 WATER ST, UNIT 604, PORTSMOUTH, VA 23704-3819
(757) 403-0429
(757) 466-9966
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2037
VA
Other
Enumeration date
03/20/2014
Last updated
03/20/2014
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