Provider Demographics
NPI:1285071084
Name:STASKEY ENTERPRISES LLC
Entity type:Organization
Organization Name:STASKEY ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CEAP
Authorized Official - Phone:757-323-2103
Mailing Address - Street 1:3650 CHIMNEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6819
Mailing Address - Country:US
Mailing Address - Phone:757-323-2103
Mailing Address - Fax:757-340-2537
Practice Address - Street 1:3650 CHIMNEY CREEK DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6819
Practice Address - Country:US
Practice Address - Phone:757-323-2103
Practice Address - Fax:757-340-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health