| Southside Group Homes, Llc | |
|
3400 Airline Blvd Portsmouth VA 23701-2623 | |
| (757) 673-1483 | |
| Not Available |
| Full Name | Southside Group Homes, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3400 Airline Blvd, Portsmouth, Virginia |
| Authorized Official Name and Position | Lisa Ann Ilapit (OWNER) |
| Authorized Official Contact | 7573621479 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Group Homes, Llc 3400 Airline Blvd Portsmouth VA 23701-2623 Ph: (757) 673-1483 | Southside Group Homes, Llc 3400 Airline Blvd Portsmouth VA 23701-2623 Ph: (757) 673-1483 |
| NPI Number | 1386208270 |
|---|---|
| Provider Enumeration Date | 04/25/2019 |
| Last Update Date | 04/25/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386208270 | NPI | - | NPPES |
| 0610652114 | Medicaid | VA | |
| 0730265045 | Medicaid | VA | |
| 0173726701 | Medicaid | VA | |
| 0243633416 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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