Healthcare Provider Details

I. General information

NPI: 1285217844
Provider Name (Legal Business Name): RIGHT PATH VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9529 LOMOND DR
MANASSAS VA
20109-3154
US

IV. Provider business mailing address

9529 LOMOND DR
MANASSAS VA
20109-3154
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-7038
  • Fax:
Mailing address:
  • Phone: 240-486-7038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KHADIJA B JALLOH
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 703-682-0272