Provider Demographics
NPI:1457896409
Name:VIRTUES OF LOVE PLACE LLC
Entity Type:Organization
Organization Name:VIRTUES OF LOVE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-213-6728
Mailing Address - Street 1:203 NORTH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-3620
Mailing Address - Country:US
Mailing Address - Phone:301-213-6728
Mailing Address - Fax:
Practice Address - Street 1:203 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-3620
Practice Address - Country:US
Practice Address - Phone:301-213-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services