Organization
UNIQUE FRIENDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN LAVERNE WALTON (ADMINISTRATOR)
(757) 484-4009
Entity
Organization
Contact information
Practice address
3805 OLD FARM RD, PORTSMOUTH, VA 23703
(757) 484-4009
(757) 686-8990
Mailing address
3805 OLD FARM RD, PORTSMOUTH, VA 23703
(757) 484-4009
(757) 686-8990
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45401001
FIRST HEALTH DMAS
VA
Enumeration date
10/23/2006
Last updated
08/22/2020
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