Provider Demographics
NPI:1528292786
Name:GROVE HOUSE
Entity type:Organization
Organization Name:GROVE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-523-7702
Mailing Address - Street 1:2317 WESTWOOD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4007
Mailing Address - Country:US
Mailing Address - Phone:804-523-7702
Mailing Address - Fax:866-383-5281
Practice Address - Street 1:6719 IRONGATE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-2840
Practice Address - Country:US
Practice Address - Phone:804-523-7702
Practice Address - Fax:833-383-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness