Provider Demographics
NPI:1962852343
Name:LUMEN CHRISTI HOME OF VIRGINIA CORPORATION
Entity Type:Organization
Organization Name:LUMEN CHRISTI HOME OF VIRGINIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:IRIA
Authorized Official - Last Name:AIKHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-228-5893
Mailing Address - Street 1:177 S PLAZA TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5557
Mailing Address - Country:US
Mailing Address - Phone:757-228-5893
Mailing Address - Fax:757-282-6374
Practice Address - Street 1:177 S PLAZA TRL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5557
Practice Address - Country:US
Practice Address - Phone:757-228-5893
Practice Address - Fax:757-282-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2280320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2280OtherDEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES