Organization
COMPASSION HOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANORA BROCKMAN (PROGRAM ADMINISTRATOR)
(757) 923-1937
Entity
Organization
Contact information
Practice address
3649 RIVERSIDE DR, NORFOLK, VA 23502-4351
(757) 923-1937
(757) 923-1938
Mailing address
3649 RIVERSIDE DR, NORFOLK, VA 23502-4351
(757) 923-1937
(757) 923-1938
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
347C00000X
Private Vehicle
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
MEDICAID WAIVER ID PENDING
VA
Enumeration date
11/13/2009
Last updated
11/13/2009
Update your record
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