Provider Demographics
NPI:1033516026
Name:LIFE IS GOLDEN - KATHY L BUTLER, INC.
Entity Type:Organization
Organization Name:LIFE IS GOLDEN - KATHY L BUTLER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-286-6913
Mailing Address - Street 1:5750 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1454
Mailing Address - Country:US
Mailing Address - Phone:757-488-3761
Mailing Address - Fax:757-488-4676
Practice Address - Street 1:5750 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1454
Practice Address - Country:US
Practice Address - Phone:757-488-3761
Practice Address - Fax:757-488-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2228251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services