Healthcare Provider Details

I. General information

NPI: 1487435863
Provider Name (Legal Business Name): RESPITE HOME OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13012 MAY HILL CT
FAIRFAX VA
22033-3652
US

IV. Provider business mailing address

415 SENECA RD
GREAT FALLS VA
22066-1114
US

V. Phone/Fax

Practice location:
  • Phone: 703-209-5160
  • Fax:
Mailing address:
  • Phone: 703-209-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DEEPA GILL
Title or Position: OWNER
Credential:
Phone: 703-209-5160