Provider Demographics
NPI:1790931509
Name:NAOMI'S PLACE, LLC
Entity Type:Organization
Organization Name:NAOMI'S PLACE, LLC
Other - Org Name:NAOMI'S PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-6036
Mailing Address - Street 1:5500 BARNSLEY TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-3424
Mailing Address - Country:US
Mailing Address - Phone:804-833-6036
Mailing Address - Fax:804-360-0660
Practice Address - Street 1:4512 SADLER GROVE CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6181
Practice Address - Country:US
Practice Address - Phone:804-833-6036
Practice Address - Fax:804-360-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
VA4071251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management