Healthcare Provider Details

I. General information

NPI: 1134906043
Provider Name (Legal Business Name): FRIENDSHIP CARE FIRST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8476 MAGIC TREE CT
SPRINGFIELD VA
22153-3811
US

IV. Provider business mailing address

8476 MAGIC TREE CT
SPRINGFIELD VA
22153-3811
US

V. Phone/Fax

Practice location:
  • Phone: 301-502-9706
  • Fax: 703-646-4113
Mailing address:
  • Phone: 301-502-9706
  • Fax: 703-646-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ONEIL DOBGIMA GALEGA
Title or Position: PROGRAM DIRECTOR
Credential: RN, MSN
Phone: 301-502-9706