Provider Demographics
NPI:1518643899
Name:LASSITER SPONSORED RESIDENTIAL SERVICES LLC
Entity Type:Organization
Organization Name:LASSITER SPONSORED RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:BABETTE
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-470-8363
Mailing Address - Street 1:1816 SILVERIA ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1760
Mailing Address - Country:US
Mailing Address - Phone:757-470-8363
Mailing Address - Fax:757-937-9309
Practice Address - Street 1:1816 SILVERIA ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1760
Practice Address - Country:US
Practice Address - Phone:757-470-8363
Practice Address - Fax:757-937-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services