Healthcare Provider Details

I. General information

NPI: 1811829740
Provider Name (Legal Business Name): THE VILLAGE RESIDENTIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43146 CROSSWIND TER
BROADLANDS VA
20148-5318
US

IV. Provider business mailing address

43146 CROSSWIND TER
BROADLANDS VA
20148-5318
US

V. Phone/Fax

Practice location:
  • Phone: 703-855-0503
  • Fax:
Mailing address:
  • Phone: 703-855-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: SUAD JAMA
Title or Position: FOUNDER
Credential: CEO
Phone: 703-855-0503