NPIMap

Organization Active NPI

House of Refuge Restoration, LLC

  • Clinical Social Worker
  • Chesapeake, VA
National Provider Identifier
1124255260
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904006954 Issued in VA
Legal business name
HOUSE OF REFUGE RESTORATION, LLC
Practice address
805 Shadowberry CRST
Chesapeake, VA 23320-3544
Phone
(757) 560-1944
Fax
(877) 468-5361
NPI assigned
Jun 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teisha Etheridge, BS
Title
Program Director
Phone
(757) 560-1944

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 0812000532 VA
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 0710102115 VA
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 0710102115 VA
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 0904006954 VA Primary

Addresses

Primary practice location

805 Shadowberry CRST
Chesapeake, VA 23320-3544

Mailing address

805 Shadowberry CRST
Chesapeake, VA 23320-3544
Phone (757) 560-1944

Other names 1

  • House of refuge Other name

National Provider Directory

National Provider Directory
Tax ID family
House of Refuge2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1124255260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SHADOWBERRY CRST",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203544",
            "telephone_number": "757-560-1944",
            "fax_number": "877-468-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 SHADOWBERRY CRST",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203544",
            "telephone_number": "757-560-1944",
            "fax_number": "877-468-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSE OF REFUGE RESTORATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "ETHERIDGE",
        "authorized_official_first_name": "TEISHA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "757-560-1944",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "VA",
            "license": "0812000532",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "VA",
            "license": "0710102115",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710102115",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "House of refuge",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.