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General NPI Number Information
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NPI Number | 1023835998
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Entity Type | Organization
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Legal Business Name | LILY ROSE RESIDENTIAL SERVICES-DC INC
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 3516 PLANK RD STE 5C
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6861
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Country | US
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Telephone | 703-407-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 3516 PLANK RD STE 5C
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6861
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Country | US
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Telephone | 703-407-1011
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHIKATA KHYNE-SAM
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Credential |
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Telephone | 703-407-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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