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General NPI Number Information
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NPI Number | 1023133899
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Entity Type | Organization
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Legal Business Name | ESTELLE PLACE LLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 17985 POSSUM POINT RD
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City | DUMFRIES
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State | VA
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Zip | 22026-2646
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Country | US
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Telephone | 703-221-9929
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Fax | 703-221-9919
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Provider Business Mailing Address
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Address Line | 17964 SWANS CREEK LN
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City | DUMFRIES
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State | VA
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Zip | 22026-4526
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Country | US
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Telephone | 703-221-9929
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Fax | 703-221-9919
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Authorized Official
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Title or Position | CEO
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Name | MRS. DEBORAH C ROUNDTREE
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Credential | MA
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Telephone | 703-221-9929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 755-01-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 755-02-006
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License Number State | VA
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