Healthcare Provider Details

I. General information

NPI: 1902712490
Provider Name (Legal Business Name): XYLIS HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 EISENHOWER AVE STE 251
ALEXANDRIA VA
22314-4698
US

IV. Provider business mailing address

2121 EISENHOWER AVE STE 251
ALEXANDRIA VA
22314-4698
US

V. Phone/Fax

Practice location:
  • Phone: 240-639-2059
  • Fax:
Mailing address:
  • Phone: 240-639-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXANDER TANYI BETCHEM
Title or Position: CEO / ADMINISTRATOR
Credential:
Phone: 240-639-2059