Provider Demographics
NPI:1386802759
Name:ACHIEVERS HOUSE
Entity type:Organization
Organization Name:ACHIEVERS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEMOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELUGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-339-7172
Mailing Address - Street 1:1702 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4405
Mailing Address - Country:US
Mailing Address - Phone:757-440-3774
Mailing Address - Fax:757-321-2881
Practice Address - Street 1:1702 BROWN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4405
Practice Address - Country:US
Practice Address - Phone:757-440-3774
Practice Address - Fax:757-321-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1031-14-001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness