Healthcare Provider Details

I. General information

NPI: 1508779455
Provider Name (Legal Business Name): NOBLE HAVEN LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 SEMINARY RD STE 311
FALLS CHURCH VA
22041-3066
US

IV. Provider business mailing address

5707 SEMINARY RD STE 311
FALLS CHURCH VA
22041-3066
US

V. Phone/Fax

Practice location:
  • Phone: 703-899-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: ZOOLFIYA ACHILOVA
Title or Position: DIRECTOR
Credential:
Phone: 703-899-2191