Provider Demographics
NPI:1730310301
Name:MORRISON COMPREHENSIVE LEARNING CENTER, LLC
Entity type:Organization
Organization Name:MORRISON COMPREHENSIVE LEARNING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:757-897-7844
Mailing Address - Street 1:301 GOODE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-393-1300
Mailing Address - Fax:757-393-2300
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-393-1300
Practice Address - Fax:757-393-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORRISON COMPREHENSIVE LEARNING CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-30
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001134042251J00000X, 251S00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730310301Medicaid
VA0102507149Medicaid
VA0102507149Medicaid