Organization
SHEPHERDS LODGE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIE R GUESS B.S. (EXECUTIVE DIRECTOR)
(757) 477-5957
Entity
Organization
Contact information
Practice address
3337 KILLIAN AVE, PORTSMOUTH, VA 23704-6024
(757) 393-3408
(757) 397-0316
Mailing address
3337 KILLIAN AVE, PORTSMOUTH, VA 23704-6024
(757) 393-3408
(757) 397-0316
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
701
VA
Other
Enumeration date
08/15/2006
Last updated
08/22/2020
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