Momentum 180 LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

MOMENTUM 180 LLC

Practice address

739 Thimble Shoals Blvd Ste 503
Newport News, VA 23606-3562

Phone

(757) 782-4220

Fax

(757) 942-2321

NPI assigned

Sep 9, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Dwayne Lamont Wilson, BS, QDDP

Title

Owner

Phone

(757) 636-0884

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1730794603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 RUTLAND DR",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662688",
            "telephone_number": "757-636-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 THIMBLE SHOALS BLVD STE 503",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236063562",
            "telephone_number": "757-782-4220",
            "fax_number": "757-942-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM 180 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-636-0884",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS, QDDP"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Haley Moniuszko, FNP
• Montague L Martin DDS

• Developmentally Disabled Services Day Training Agency in Newport News, VA
• Providers in Newport News, VA by specialty
• Developmentally Disabled Services Day Training Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.