Provider Demographics
NPI:1265776751
Name:SISTER'S DEVELOPING GROWTH & CHANGE, LLC
Entity type:Organization
Organization Name:SISTER'S DEVELOPING GROWTH & CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENDA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WHITLEY-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-327-6752
Mailing Address - Street 1:1410 CARSON CRESCENT WEST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701
Mailing Address - Country:US
Mailing Address - Phone:757-327-6752
Mailing Address - Fax:
Practice Address - Street 1:6101 BRADFORD DRIVE #B
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-967-0785
Practice Address - Fax:757-335-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA#133601001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities