Healthcare Provider Details

I. General information

NPI: 1477481109
Provider Name (Legal Business Name): GLORY DAYS RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 PURI LN
STAFFORD VA
22554-8201
US

IV. Provider business mailing address

28 PURI LN
STAFFORD VA
22554-8201
US

V. Phone/Fax

Practice location:
  • Phone: 540-930-4081
  • Fax: 540-274-3861
Mailing address:
  • Phone: 540-930-4081
  • Fax: 540-274-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: FATMATA ENDELEY
Title or Position: ADMINISTRATOR
Credential: RN.MSN
Phone: 703-459-4365