Organization
IVEYHOUSE LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY EDWARD LINDSTOM (CEO)
(804) 382-3741
Entity
Organization
Contact information
Practice address
2222 COLSTON ST, PETERSBURG, VA 23805-2204
(804) 835-9137
(804) 835-9153
Mailing address
925 EDINBOROUGH DR, COLONIAL HEIGHTS, VA 23834-2611
(804) 835-9137
(804) 835-9153
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0002369
VA
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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