Organization
HOUSE OF REFUGE RESTORATION,LLC
Active
Other names
House of Refuge Ministries, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TEISHA ETHERIDGE BS (PROGRAM DIRECTOR)
(757) 560-1944
Entity
Organization
Contact information
Practice address
805 SHADOWBERRY CRST, CHESAPEAKE, VA 23320-3544
(757) 436-2201
(877) 468-5361
Mailing address
805 SHADOWBERRY CREST, CHESAPEAKE, VA 23320-3544
(757) 560-1944
(877) 468-5361
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
VA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
VA
385HR2055X
Child Mental Illness Respite Care
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117414794
—
VA
05
—
1326230640
—
VA
Enumeration date
11/05/2008
Last updated
06/09/2009
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