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General NPI Number Information
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NPI Number | 1295433969
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Entity Type | Organization
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Legal Business Name | PETIT'S HALO, LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 714 HOPE RD
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City | STAFFORD
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State | VA
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Zip | 22554-5226
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Country | US
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Telephone | 540-317-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 10 WINDRUSH CT
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City | STAFFORD
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State | VA
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Zip | 22554-5446
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Country | US
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Telephone | 540-317-6267
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | CLAUNISE PETIT
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Credential |
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Telephone | 540-317-6267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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