Provider Demographics
NPI:1528508264
Name:FAMILY EXTENSIONS, LLC
Entity type:Organization
Organization Name:FAMILY EXTENSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-822-6337
Mailing Address - Street 1:779 LESNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-2503
Mailing Address - Country:US
Mailing Address - Phone:757-822-6337
Mailing Address - Fax:888-704-5051
Practice Address - Street 1:779 LESNER AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-2503
Practice Address - Country:US
Practice Address - Phone:757-822-6337
Practice Address - Fax:888-704-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2030-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities