The Olivia Taylor House, LLC

NPI #1386233419 in Petersburg, Virginia

Provider Information

NPI Number: 1386233419
Entity Type: Organization
Organization Name: The Olivia Taylor House, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jan 13, 2021
Last Updated: Jan 13, 2021

Practice Location

Address: 628 OLD WAGNER RD
City: Petersburg
State: Virginia
ZIP Code: 23805-9319
Phone: (804) 605-6146

Authorized Official

Name: T'ANDREA LENON GRAHAM, MSW SOCIAL; B.S. PSY
Title: EXECUTIVE DIRECTOR/OWNER
Phone: (804) 605-6146

Specialties & Taxonomy Codes

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

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