Organization
LIFE WAY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVANA A GRAY (OWNER/PARTNER)
(804) 296-7875
Entity
Organization
Contact information
Practice address
7228 STATESMAN BLVD, RUTHER GLEN, VA 22546-5246
(804) 296-7875
Mailing address
7228 STATESMAN BLVD, RUTHER GLEN, VA 22546-5246
(804) 296-7875
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8042967875
—
VA
Enumeration date
11/05/2019
Last updated
11/05/2019
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