Healthcare Provider Details

I. General information

NPI: 1508561150
Provider Name (Legal Business Name): HOME AWAY FROM HOME THE ROBINSON FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 KENMORE AVE STE 114
ALEXANDRIA VA
22304-1103
US

IV. Provider business mailing address

4801 KENMORE AVE STE 114
ALEXANDRIA VA
22304-1103
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-5479
  • Fax: 571-312-3179
Mailing address:
  • Phone: 202-607-5479
  • Fax: 571-312-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: WANDA SCOTT
Title or Position: PRESIDENT
Credential:
Phone: 202-607-5479