Organization
WCCB
Active
Parent organization
000000000000000000
Organization subpart
Yes
Provider details
NPI number
Legal business name
000000000000000000
Authorized official
MRS. CRYSTAL M LARIOS (LPTA)
(757) 842-2437
Entity
Organization
Contact information
Practice address
3100 SHORE DRIVE, VIRGINIA BEACH, VA 23451-9864
(757) 842-2437
Mailing address
1421 BRADEN CRES, NORFOLK, VA 23502-2108
(757) 842-2437
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
2306602413
VA
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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