Organization
PETERSON FAMILY CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES PETERSON (PRESIDENT)
(757) 399-1924
Entity
Organization
Contact information
Practice address
1632 ELM AVE, PORTSMOUTH, VA 23704-4508
(757) 399-1924
Mailing address
1632 ELM AVE, PORTSMOUTH, VA 23704-4508
(757) 399-1924
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
Other
Enumeration date
12/22/2006
Last updated
08/22/2020
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