Provider Demographics
NPI:1225648165
Name:ANDREAS HOUSE LLC.
Entity Type:Organization
Organization Name:ANDREAS HOUSE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-339-8033
Mailing Address - Street 1:999 WATERSIDE DR STE 2520
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-3300
Mailing Address - Country:US
Mailing Address - Phone:757-339-8033
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR STE 2520
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3300
Practice Address - Country:US
Practice Address - Phone:757-339-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3336Medicaid