Provider Demographics
NPI:1790226215
Name:B & R SUPPORTIVE LIVING, LLC
Entity Type:Organization
Organization Name:B & R SUPPORTIVE LIVING, LLC
Other - Org Name:B&R SUPPORTIVE LIVING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WYNTER
Authorized Official - Middle Name:WYNETTE
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:757-367-1961
Mailing Address - Street 1:5752 ANDREA DR
Mailing Address - Street 2:NORFOLK, VA 23518
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-5743
Mailing Address - Country:US
Mailing Address - Phone:757-367-1961
Mailing Address - Fax:757-499-6323
Practice Address - Street 1:5752 ANDREA DR
Practice Address - Street 2:NORFOLK, VA 23518
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-5743
Practice Address - Country:US
Practice Address - Phone:757-367-1961
Practice Address - Fax:757-499-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility