Provider Demographics
NPI:1215455241
Name:NEIGHBORLY RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:NEIGHBORLY RESIDENTIAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED AIDE
Authorized Official - Phone:804-709-1736
Mailing Address - Street 1:4135 HOLCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3033
Mailing Address - Country:US
Mailing Address - Phone:804-743-8618
Mailing Address - Fax:804-709-1788
Practice Address - Street 1:2404 NORTHUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1525
Practice Address - Country:US
Practice Address - Phone:804-709-1736
Practice Address - Fax:804-709-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid