NPI 1063609659

Annzetta's Therapeutic Home for Boys, LLC

Organisation Mental Illness Community Based Residential Treatment Facility Petersburg, VA

Practice location

Address: 1834 Buckner St, Petersburg, VA 23805-1705
Phone: (804) 863-2661

Authorised official

Name: Mary Emma Harris
Title: Office Clerk
Phone: (804) 861-5182

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X

Other Community Based Residential Treatment Facility, Mental Illness providers in Virginia →

Registry record

NPI: 1063609659
Entity type: Organization
NPI issued: 27 Sep 2007
Record last updated: 25 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.