ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC (NPI# 1063609659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063609659 |
| Entity Type | Organization |
| Organization Name | ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC |
| Practice Address |
1834 Buckner St Petersburg VA 23805-1705 |
| Practice Telephone | 8048632661 |
| Mailing Telephone | 8048632661 |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-10-25 |
| Authorized Official Name | MARY EMMA HARRIS (OFFICE CLERK) |
| Authorized Official Telephone | 8048615182 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Street Address |
1834 BUCKNER ST |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891008710 | Nadiya House, LLC | Community Based Residential Treatment Facility, Mental Illness | 123 S Chappell St, Petersburg, VA 23803-3910 | 2010-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487901 | River City Residential Services, LLC | Community Based Residential Treatment Facility, Mental Illness | 2106 Hungary Rd, Richmond, VA 23228-2208 | 2020-04-27 |
| 1376178079 | Scott's Rehabilitative House | Community Based Residential Treatment Facility, Mental Illness | 104 Country Club Rd, Franklin, VA 23851-2983 | 2020-03-03 |
| 1386298354 | Quality Care Counseling Services, LLC | Community Based Residential Treatment Facility, Mental Illness | 18511 Rollingside Dr, South Chesterfield, VA 23834-1699 | 2019-07-29 |
| 1730690694 | Families United, LLC | Community Based Residential Treatment Facility, Mental Illness | 1801 Hayward Ave, Chesapeake, VA 23320-2231 | 2017-10-18 |
| 1427419035 | Powerhouse Unlimited | Community Based Residential Treatment Facility, Mental Illness | 418 N 25th St, Apt 260, Richmond, VA 23223-7564 | 2016-03-09 |
| 1700266277 | Jan's Residential Homes | Community Based Residential Treatment Facility, Mental Illness | 307 N High St, Blackstone, VA 23824-1421 | 2015-05-31 |
| 1225426083 | Divine Health Support LLC | Community Based Residential Treatment Facility, Mental Illness | 2050 Hanson Ln, Woodbridge, VA 22191-4545 | 2015-01-02 |
| 1063838126 | New Lifestyles, Inc | Community Based Residential Treatment Facility, Mental Illness | 230 W Boscawen St, Winchester, VA 22601-4118 | 2014-03-13 |
| 1053742049 | Pathways Youth Services LLC | Community Based Residential Treatment Facility, Mental Illness | 1010 Marions Trl, Halifax, VA 24558-3126 | 2013-12-02 |
| 1679905269 | Rest Haven LLC | Community Based Residential Treatment Facility, Mental Illness | 1005 Bland St, Norfolk, VA 23513-3386 | 2013-08-06 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on ANNZETTA'S THERAPEUTIC HOME FOR BOYS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.