Provider Demographics
NPI:1245478221
Name:HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC.
Entity type:Organization
Organization Name:HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROBIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-727-2577
Mailing Address - Street 1:132 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-5542
Mailing Address - Country:US
Mailing Address - Phone:757-245-0529
Mailing Address - Fax:
Practice Address - Street 1:1320 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3801
Practice Address - Country:US
Practice Address - Phone:757-727-2577
Practice Address - Fax:757-723-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166077261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health