Healthcare Provider Details

I. General information

NPI: 1508777434
Provider Name (Legal Business Name): SILOAM COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14080 SULLYFIELD CIR
CHANTILLY VA
20151-1623
US

IV. Provider business mailing address

14080 SULLYFIELD CIR
CHANTILLY VA
20151-1623
US

V. Phone/Fax

Practice location:
  • Phone: 309-868-0288
  • Fax: 313-971-1720
Mailing address:
  • Phone: 309-868-0288
  • Fax: 313-971-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ONYINYECHI MGBACHI
Title or Position: ONER/PMHNP
Credential: DNP, PMHNP-BC
Phone: 309-868-0288