| NPI | 1902261159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DEBNAM Administrator 703-470-8391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 236201001) |
| Additional Taxonomies | 251C00000X (Licence: VA 236201001) |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: VA 236201001) | |
| 347C00000X Private Vehicle (Licence: VA 236201001) | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: VA 236201001) | |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |