Provider Demographics
NPI:1710720156
Name:PRAYER ASSISTIVE HOUSING, INC.
Entity type:Organization
Organization Name:PRAYER ASSISTIVE HOUSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-214-5242
Mailing Address - Street 1:799 53RD ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2074
Mailing Address - Country:US
Mailing Address - Phone:757-214-5242
Mailing Address - Fax:
Practice Address - Street 1:1603 BASIE CRES
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3933
Practice Address - Country:US
Practice Address - Phone:757-214-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities