Provider Demographics
NPI:1023188620
Name:STRONG FOUNDATION YOUTH INITIATIVE, LLC
Entity Type:Organization
Organization Name:STRONG FOUNDATION YOUTH INITIATIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QMHP
Authorized Official - Phone:804-283-6194
Mailing Address - Street 1:6001 LAKESIDE AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5735
Mailing Address - Country:US
Mailing Address - Phone:804-283-6194
Mailing Address - Fax:
Practice Address - Street 1:6001 LAKESIDE AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5735
Practice Address - Country:US
Practice Address - Phone:804-283-6194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA806320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities