Organization
GUTHER LEE'S RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT DEBNAM (ADMINISTRATOR)
(703) 470-8391
Entity
Organization
Contact information
Practice address
5 LOUDER CT, PORTSMOUTH, VA 23701-3718
(757) 967-8513
Mailing address
8177 DICKINSON CT, MANASSAS, VA 20111-2584
(703) 470-8391
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
236201001
VA
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
236201001
VA
343900000X
Non-emergency Medical Transport (VAN)
236201001
VA
347C00000X
Private Vehicle
236201001
VA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
236201001
VA
Other
Enumeration date
12/15/2015
Last updated
12/15/2015
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