OrganizationActive
Abundant Life Therapeutic Services LLC
NPI 1285076067 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Norfolk, VA
Provider details
- NPI number
- 1285076067
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Melvin Anderson, Executive Director(757) 616-0657
- License
- 2154 (VA)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense 2154 (VA)
Residential Treatment Facilities
Practice location
645 Church St.
Suite 104c
Norfolk, VA 23510
Phone: (757) 616-0657
Fax: (757) 533-9369
Approximate (ZIP-level) locationGet directions
Mailing address
645 Church St
Norfolk, VA 23510-1712
Registry dates
- Enumerated
- 2013-07-22
- Last updated
- 2015-06-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.