Healthcare Provider Details

I. General information

NPI: 1215260492
Provider Name (Legal Business Name): G&G RESPITE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2009
Last Update Date: 09/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 BURROUGH HILL LN
WOODBRIDGE VA
22191-5155
US

IV. Provider business mailing address

2810 BURROUGH HILL LN
WOODBRIDGE VA
22191-5155
US

V. Phone/Fax

Practice location:
  • Phone: 703-973-8821
  • Fax: 703-796-9615
Mailing address:
  • Phone: 703-973-8821
  • Fax: 703-796-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE VUMAH MBENGABONG
Title or Position: REHAB.SPECIALIST
Credential:
Phone: 703-973-8821