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General NPI Number Information
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NPI Number | 1215260492
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Entity Type | Organization
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Legal Business Name | G&G RESPITE SERVICES
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Dates
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Enumeration Date | 09/06/2009
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Last Update Date | 09/06/2009
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Provider Practice Location Address
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Address Line | 2810 BURROUGH HILL LN
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5155
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Country | US
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Telephone | 703-973-8821
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Fax | 703-796-9615
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Provider Business Mailing Address
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Address Line | 2810 BURROUGH HILL LN
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5155
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Country | US
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Telephone | 703-973-8821
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Fax | 703-796-9615
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Authorized Official
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Title or Position | REHAB.SPECIALIST
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Name | MS. GRACE VUMAH MBENGABONG
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Credential |
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Telephone | 703-973-8821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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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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