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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