Provider Demographics
NPI:1740753938
Name:FAMILY SUCCESS ON SPECTRUM LLC
Entity Type:Organization
Organization Name:FAMILY SUCCESS ON SPECTRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MURTADHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-305-6849
Mailing Address - Street 1:8401 PATTERSON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6430
Mailing Address - Country:US
Mailing Address - Phone:804-305-6849
Mailing Address - Fax:
Practice Address - Street 1:8401 PATTERSON AVE STE 205
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6430
Practice Address - Country:US
Practice Address - Phone:804-305-6849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities