Providing Equal Opportunity Progressive Living Environments, LLC

NPI #1174782304 in Fredericksburg, Virginia

Provider Information

NPI Number: 1174782304
Entity Type: Organization
Organization Name: Providing Equal Opportunity Progressive Living Environments, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 3, 2008
Last Updated: Jun 3, 2008

Practice Location

Address: 10301 KUPPERTON CT
City: Fredericksburg
State: Virginia
ZIP Code: 22408-8054
Phone: (540) 373-8096

Authorized Official

Name: MR. JUSTIN DAMERON
Title: OWNER/DIRECTOR OF FINANCE
Phone: (540) 373-8096

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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