Organization
T'LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANINE JOHNSON (EXECUTIVE DIRECTOR)
(804) 721-6861
Entity
Organization
Contact information
Practice address
823 S JONES ST, PETERSBURG, VA 23803-4952
(804) 590-2227
(804) 451-9573
Mailing address
3734 W AUTUMN DR, NORTH DINWIDDIE, VA 23803-8433
(804) 721-6861
(804) 451-9573
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
38214035
VA
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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