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General NPI Number Information
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NPI Number | 1144037284
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Entity Type | Organization
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Legal Business Name | CBN HEALTHCARE RESIDENTIAL SERVICES,INC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1549 OLD BRIDGE RD STE 303
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2737
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Country | US
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Telephone | 571-398-2600
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Fax | 571-398-2599
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Provider Business Mailing Address
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Address Line | 15301 COMUS CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5877
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Country | US
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Telephone | 703-589-0630
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHIAGOZIE NWOSU
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Credential |
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Telephone | 571-398-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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