Organization
IDA MAEZ ADULT LIVING LLC
Active
Other names
IDA Maez Day Support
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONISE ANDERSON (CEO)
(757) 771-9879
Entity
Organization
Contact information
Practice address
4824 GEORGE WASHINGTON HWY, PORTSMOUTH, VA 23702-2410
(757) 537-0334
Mailing address
100 7TH ST STE 104, PORTSMOUTH, VA 23704-4800
(757) 771-9879
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/26/2023
Last updated
07/26/2023
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