Provider Demographics
NPI:1982677027
Name:HALO, INC.
Entity Type:Organization
Organization Name:HALO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGROS
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP/QMHP
Authorized Official - Phone:804-733-9140
Mailing Address - Street 1:1857A FORT MAHONE ST
Mailing Address - Street 2:P. O. BOX 28
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2761
Mailing Address - Country:US
Mailing Address - Phone:804-733-9140
Mailing Address - Fax:804-733-9216
Practice Address - Street 1:1857A FORT MAHONE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2761
Practice Address - Country:US
Practice Address - Phone:804-733-9140
Practice Address - Fax:804-733-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA523-01320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities