Provider Demographics
NPI:1881833432
Name:POWERLINE COMMUNITY DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:POWERLINE COMMUNITY DEVELOPMENT CORP.
Other - Org Name:ELAM HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-827-6937
Mailing Address - Street 1:6148 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1557
Mailing Address - Country:US
Mailing Address - Phone:757-827-6937
Mailing Address - Fax:757-827-6940
Practice Address - Street 1:610 BROOKE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1506
Practice Address - Country:US
Practice Address - Phone:757-827-6937
Practice Address - Fax:757-827-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children