Organization
MYLOTUS VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHAMIA A GILLON (EXECUTIVE DIRECTOR)
(757) 732-4362
Entity
Organization
Contact information
Practice address
36 BROOKFIELD DR, HAMPTON, VA 23666-3545
(757) 732-4362
Mailing address
36 BROOKFIELD DR, HAMPTON, VA 23666-3545
(757) 732-4362
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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