Healthcare Provider Details

I. General information

NPI: 1023087095
Provider Name (Legal Business Name): LANGLEY RESIDENTIAL SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 CHAIN BRIDGE RD SUITE 200
MC LEAN VA
22101-5723
US

IV. Provider business mailing address

1487 CHAIN BRIDGE RD SUITE 200
MC LEAN VA
22101-5723
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-0068
  • Fax: 703-893-5047
Mailing address:
  • Phone: 703-893-0068
  • Fax: 703-893-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number061-01-011
License Number StateVA

VIII. Authorized Official

Name: MS. ANNE SCHATZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-893-0068