Organization
SPAIN RESIDENTIAL PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDRE SMITH (OWNER)
(804) 523-7702
Entity
Organization
Contact information
Practice address
5941 ALMOND TREE TER, HENRICO, VA 23231-4789
(804) 523-7702
(866) 383-5281
Mailing address
2916 CHAMBERLAYNE AVE, RICHMOND, VA 23222-3506
(804) 523-7702
(866) 383-5281
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
CO-435-10
VA
Other
Enumeration date
02/26/2010
Last updated
02/26/2010
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