Lottie-Estelle Group Home, INC
NPI #1053748954 in Chase City, Virginia
Provider Information
- NPI Number
- 1053748954
- Entity Type
- Organization
- Organization Name
- Lottie-Estelle Group Home, INC
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Oct 9, 2013
- Last Updated
- Oct 9, 2013
Practice Location
- Address
- 4897 HWY 47
- City
- Chase City
- State
- Virginia
- ZIP Code
- 23924-3606
- Phone
- (434) 372-0407
Authorized Official
- Name
- MRS. TIFFANY TILLERSON TERRY
- Title
- QMRP
- Phone
- (434) 372-0407
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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