Provider Demographics
NPI:1134821135
Name:SAME LIFE SERVICES LLC
Entity type:Organization
Organization Name:SAME LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYLA
Authorized Official - Middle Name:DANICE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QDDP
Authorized Official - Phone:757-581-2063
Mailing Address - Street 1:1111 WARRINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0757
Mailing Address - Country:US
Mailing Address - Phone:757-581-2063
Mailing Address - Fax:
Practice Address - Street 1:2512 RIVER OAK DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-8136
Practice Address - Country:US
Practice Address - Phone:757-581-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities