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Organization

SHANGRI-LA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LORETTA FAULKNIER (CHIEF EXECUTIVE OFFICER)
(804) 541-3589
Entity
Organization

Contact information

Practice address
3650 BUTOR RD, NORTH PRINCE GEORGE, VA 23860-7429
(804) 541-3589
Mailing address
PO BOX 1014, PRINCE GEORGE, VA 23875-0961
(804) 541-3589

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2473
VA

Other

Enumeration date
03/14/2015
Last updated
03/14/2015
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