Commonwealth Residential Living LLC

NPI #1356825301 in Sandston, Virginia

Provider Information

NPI Number: 1356825301
Entity Type: Organization
Organization Name: Commonwealth Residential Living LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 16, 2018
Last Updated: Sep 16, 2018

Practice Location

Address: 232 TARABY DR
City: Sandston
State: Virginia
ZIP Code: 23150-2148
Phone: (804) 921-4237

Authorized Official

Name: CRYSTAL WHITE
Title: CEO
Phone: (804) 253-5529

Specialties & Taxonomy Codes

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

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