Providing Ease Residential Services
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Waverly, VA
NPI 1306559596 · NPPES record last updated Jan 3, 2023
Key facts
- NPI
- 1306559596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- PROVIDING EASE RESIDENTIAL SERVICES
- Practice address
- 218 Locust Dr
Waverly, VA 23890-5027 - Phone
- (804) 590-5706
- NPI assigned
- Jan 3, 2023
- Organization subpart
- No
Authorized official
- Name
- Sherita Johnson
- Title
- Owner
- Phone
- (804) 590-5706
Practitioners 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
218 Locust Dr
Waverly, VA 23890-5027
Mailing address
218 Locust Dr
Waverly, VA 23890-5027
Phone (804) 590-5706
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2 | Medicaid | VA |
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All providers in Waverly, VA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.