Healthcare Provider Details

I. General information

NPI: 1316852437
Provider Name (Legal Business Name): DDAVILAS LEGACY OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13820 EXETER CT
HAGERSTOWN MD
21742-5313
US

IV. Provider business mailing address

13820 EXETER CT
HAGERSTOWN MD
21742-5313
US

V. Phone/Fax

Practice location:
  • Phone: 240-291-9465
  • Fax:
Mailing address:
  • Phone: 240-291-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MS. DAYSSY DAVILA
Title or Position: OWNER / FOUNDER/LAF
Credential:
Phone: 240-291-9465