Healthcare Provider Details

I. General information

NPI: 1992724561
Provider Name (Legal Business Name): ST. JOHN'S COMMUNITY SERVICES- VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 LITTLE RIVER TURNPIKE SUITE 404 WEST
ANNANDALE VA
22003
US

IV. Provider business mailing address

7611 LITTLE RIVER TURNPIKE SUITE 404 WEST
ANNANDALE VA
22003
US

V. Phone/Fax

Practice location:
  • Phone: 703-914-2755
  • Fax: 703-914-5437
Mailing address:
  • Phone: 703-914-2755
  • Fax: 703-914-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number194-01-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number194-01-001
License Number StateVA

VIII. Authorized Official

Name: MS. THALIA SIMPSON-CLEMENT
Title or Position: VA. STATE DIRECTOR
Credential:
Phone: 703-914-2755