Provider Demographics
NPI:1255173852
Name:NATURAL NUBIAN & CO. LLC
Entity type:Organization
Organization Name:NATURAL NUBIAN & CO. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYLICIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:757-769-3260
Mailing Address - Street 1:1021 RIVER BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2779
Mailing Address - Country:US
Mailing Address - Phone:757-383-9992
Mailing Address - Fax:
Practice Address - Street 1:1021 RIVER BIRCH CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2779
Practice Address - Country:US
Practice Address - Phone:757-769-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services