Organization
EXTENDED LOVE AGENCY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE HAWKINS (OWNER)
(757) 380-0433
Entity
Organization
Contact information
Practice address
714 23RD ST, NEWPORT NEWS, VA 23607-4614
(757) 380-0433
Mailing address
714 23RD ST, NEWPORT NEWS, VA 23607-4614
(757) 380-0433
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1784
VA
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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