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General NPI Number Information
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NPI Number | 1316272628
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Entity Type | Organization
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Legal Business Name | SALVATION ACADEMY
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 4810 BEAUREGARD ST SUITE G1-4
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1709
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Country | US
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Telephone | 571-405-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 BEAUREGARD ST SUITE G1-4
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1709
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Country | US
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Telephone | 571-405-6465
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIMA BOB DEEN
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Credential | BA.,ADBS., GBM.
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Telephone | 571-217-8394
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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 |
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License Number State |
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