Organization
DIVERSITY RESIDENTIAL HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WHITTINGHAM M.ED. (DIRECTOR)
(804) 405-4000
Entity
Organization
Contact information
Practice address
5216 BAYVIEW DR, RICHMOND, VA 23234-4504
(804) 405-4000
(804) 743-1845
Mailing address
PO BOX 74425, RICHMOND, VA 23236-0008
(804) 405-4000
(804) 743-1845
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
70201001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70201001
DMHMRSAS PROVIDER #
VA
Enumeration date
01/10/2007
Last updated
08/22/2020
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