Organization
EAGLE PHOENIX RESIDENTIAL & BEHAVORIAL HEALTH SERVICES LLC
Active
Other names
Eagle Phoenix Residential & Behavorial Health Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA LOTORIA BALLOU (CEO/OWNER)
(434) 429-2649
Entity
Organization
Contact information
Practice address
1345 N MAIN ST, DANVILLE, VA 24540-3721
(434) 429-2649
Mailing address
1345 N MAIN ST, DANVILLE, VA 24540-3721
(434) 429-2649
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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