Organization
SUPPORTIVE INDEPENDENT LIFESTYLE LLC
Active
Other names
Independent Lifestyles LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM HARRIS (CEO)
(757) 383-2589
Entity
Organization
Contact information
Practice address
316 OFFICE SQUARE LN STE 101, VIRGINIA BEACH, VA 23462-3651
(757) 383-2589
Mailing address
316 OFFICE SQUARE LN STE 101, VIRGINIA BEACH, VA 23462-3651
(757) 383-2589
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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