Provider Demographics
NPI:1225800956
Name:ASOCA
Entity Type:Organization
Organization Name:ASOCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:BENITA
Authorized Official - Last Name:LIPFORD-RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-768-3903
Mailing Address - Street 1:142 MARCELLA RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2552
Mailing Address - Country:US
Mailing Address - Phone:757-768-3903
Mailing Address - Fax:757-825-2562
Practice Address - Street 1:4410 EAST CLAIBORNE STREET, SUITE 334
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-768-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASOCA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities