Organization
THERESA'-VENIA, LLC
Active
Other names
Corine's Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEOLIA BROWN (ADMINISTRATOR EXECUTIVE DIRECTOR)
(757) 513-2074
Entity
Organization
Contact information
Practice address
1536 CENTRE AVE, PORTSMOUTH, VA 23704-6802
(757) 967-9545
Mailing address
4107 PORTSMOUTH BLVD, 101-35, CHESAPEAKE, VA 23321-2140
(757) 513-2074
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000005002
TRACKING NO
VA
Enumeration date
11/30/2006
Last updated
09/11/2025
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