Organization
EDIFYING LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONYA WEBB (DIRECTOR)
(757) 333-9264
Entity
Organization
Contact information
Practice address
204 W 33RD ST, NORFOLK, VA 23504-1408
(757) 333-9264
Mailing address
204 W 33RD ST, NORFOLK, VA 23504-1408
(757) 333-9264
(757) 333-9264
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
OHS 2089
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2089
—
VA
Enumeration date
12/02/2014
Last updated
12/02/2014
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