Provider Demographics
NPI:1275699076
Name:WINDSOR MANOR TRAINING HOME ADULT MIN.
Entity Type:Organization
Organization Name:WINDSOR MANOR TRAINING HOME ADULT MIN.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:343-847-1219
Mailing Address - Street 1:1104 ARDMORE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2234
Mailing Address - Country:US
Mailing Address - Phone:434-385-4799
Mailing Address - Fax:434-847-3230
Practice Address - Street 1:1010 4TH ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2806
Practice Address - Country:US
Practice Address - Phone:434-385-4799
Practice Address - Fax:434-847-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0100059631320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities