Healthcare Provider Details

I. General information

NPI: 1801602529
Provider Name (Legal Business Name): ALAFIA GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SUNRISE CT
HERNDON VA
20170-4119
US

IV. Provider business mailing address

1215 SUNRISE CT
HERNDON VA
20170-4119
US

V. Phone/Fax

Practice location:
  • Phone: 703-587-5303
  • Fax:
Mailing address:
  • Phone: 703-587-5303
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: FIRSTINA ROSE
Title or Position: CEO
Credential:
Phone: 703-587-5303