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LOTTIE-ESTELLE GROUP HOME, INC

Intermediate Care Mentally Retarded

Chase City, Virginia

Provider NPI: 1053748954

Organization Information:
Organization Name:  LOTTIE-ESTELLE GROUP HOME, INC
Organization is not Subpart
Authorized Official:  TIFFANY TILLERSON TERRY  QMRP  434-3720407

Practice Location:
4897 HWY 47  CHASE CITY, VA 23924 US
Tel: 434-372-0407  Fax: 434-372-0394

Business Mailing Address:
4883 HWY 47  CHASE CITY, VA 23924 US
Tel: 434-372-0407  Fax: 434-372-0394

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
VA808









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