Healthcare Provider Details

I. General information

NPI: 1447827720
Provider Name (Legal Business Name): SIBLINGS RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 KAIN RD
GLEN ALLEN VA
23059-5722
US

IV. Provider business mailing address

2531 PERCH LN
GLEN ALLEN VA
23060-5889
US

V. Phone/Fax

Practice location:
  • Phone: 571-224-6741
  • Fax:
Mailing address:
  • Phone: 571-224-6741
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MESKEREM LULSEGED WENDAFRASH
Title or Position: OWNER
Credential:
Phone: 571-224-6741