NPIMap

Organization Active NPI

Providing Equal Opportunity Progressive Living Environments, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Fredericksburg, VA
National Provider Identifier
1174782304
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
112501001 Issued in VA
Legal business name
PROVIDING EQUAL OPPORTUNITY PROGRESSIVE LIVING ENVIRONMENTS, LLC
Practice address
10301 Kupperton CT
Fredericksburg, VA 22408-8054
Phone
(540) 373-8096
NPI assigned
Jun 3, 2008
Last updated
Jun 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

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

Authorized official

Name
Mr. Justin Dameron
Title
Owner/Director of Finance
Phone
(540) 373-8096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 112501001 VA Primary

Addresses

Primary practice location

10301 Kupperton CT
Fredericksburg, VA 22408-8054

Mailing address

10301 Kupperton CT
Fredericksburg, VA 22408-8054
Phone (540) 373-8096

Other identifiers 1

IdentifierTypeStateIssuer
112501001OtherVADEPARTMENT OF MENTAL HEALTH MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES

Other names 1

  • P.E.O.P.L.E., LLC (acronymn for company name) Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1174782304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 KUPPERTON CT",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224088054",
            "telephone_number": "540-373-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 KUPPERTON CT",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224088054",
            "telephone_number": "540-373-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDING EQUAL OPPORTUNITY PROGRESSIVE LIVING ENVIRONMENTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "DAMERON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER/DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "540-373-8096",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "112501001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF MENTAL HEALTH MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES",
            "identifier": "112501001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P.E.O.P.L.E., LLC (acronymn for company name)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; 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.