NPI 1093110439

Fannie's Divine Miracles,llc

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Portsmouth, VA

Practice location

Address: 1100 Holladay St, Portsmouth, VA 23704-2232
Phone: (757) 729-0009
Fax: (757) 966-5334

Authorised official

Name: Irish Caine
Title: Executive Director
Phone: (757) 729-0009

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 1956 (VA)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Virginia →

Registry record

NPI: 1093110439
Entity type: Organization
NPI issued: 28 Oct 2014
Record last updated: 28 Oct 2014

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.