Organization
SUPPORTIVE RESIDENTIAL LLC
Active
Organization
SUPPORTIVE RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY RENEE CLARK (EXECUTIVE DIRECTOR)
(804) 305-4790
Entity
Organization
Contact information
Practice address
934 PLEASANT ST, RICHMOND, VA 23223-6190
(804) 305-4790
Mailing address
8005 REEDY BRANCH RD, CHESTERFIELD, VA 23838-5710
(804) 305-4790
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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