Southside Group Homes, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SOUTHSIDE GROUP HOMES, LLC

Doing business as

Southside Group Homes

Practice address

3400 Airline Blvd
Portsmouth, VA 23701-2623

Phone

(757) 673-1483

NPI assigned

Apr 25, 2019

Organization subpart

No

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

Authorized official

Name

Lisa Ann Ilapit

Title

Owner

Phone

(757) 362-1479

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Southside Group Homes Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1386208270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012623",
            "telephone_number": "757-673-1483",
            "fax_number": "757-405-6326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237012623",
            "telephone_number": "757-673-1483"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3802 Brighton Street",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "23707",
            "country_code": "US",
            "telephone_number": "757-673-1483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "903 Basie Cres",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237013927",
            "country_code": "US",
            "telephone_number": "757-673-1483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5532 Springwood Dr",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237033537",
            "country_code": "US",
            "telephone_number": "757-673-1483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHSIDE GROUP HOMES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "ILAPIT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-362-1479"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0610652114",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0730265045",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0173726701",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0243633416",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@southsidegroupva.com",
            "affiliation": "N",
            "address_1": "3400 Airline Blvd",
            "city": "Portsmouth",
            "state": "VA",
            "country_code": "US",
            "postal_code": "237012623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Southside Group Homes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; 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.