Provider Demographics
NPI:1093768921
Name:LOUISE W. EGGLESTON CENTER
Entity Type:Organization
Organization Name:LOUISE W. EGGLESTON CENTER
Other - Org Name:EGGLESTON SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-858-8011
Mailing Address - Street 1:1161 INGLESIDE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5608
Mailing Address - Country:US
Mailing Address - Phone:757-858-8011
Mailing Address - Fax:757-627-4760
Practice Address - Street 1:6431 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1600
Practice Address - Country:US
Practice Address - Phone:757-858-8011
Practice Address - Fax:757-858-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA16702006251C00000X
VA16701001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities