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THERESA'-VENIA, LLC

Intermediate Care Facility, Mental Illness

Portsmouth, Virginia

Provider NPI: 1891863973

Organization Information:
Organization Name:  THERESA'-VENIA, LLC


Practice Location:
1536 CENTRE AVE  PORTSMOUTH, VA 23704 US
Tel: 757-967-9545  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness
X315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded

Other Provider Identifiers:

IssuerNumberStateType
TRACKING NO0000005002VA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




INTERMEDIATE CARE JOBS VA - Page 1



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