Healthcare Provider Details

I. General information

NPI: 1518884675
Provider Name (Legal Business Name): ABETHA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14526 FULLERTON RD
WOODBRIDGE VA
22193-2035
US

IV. Provider business mailing address

14104 ABERDEENS FOLLY CT
BOWIE MD
20720-5804
US

V. Phone/Fax

Practice location:
  • Phone: 240-755-7503
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name: OUSMANE BALDE
Title or Position: DIRECTOR
Credential:
Phone: 240-755-7503