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General NPI Number Information
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NPI Number | 1497342539
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Entity Type | Organization
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Legal Business Name | AMAZING LYF SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 245 GARRISONVILLE RD STE 102
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City | STAFFORD
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State | VA
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Zip | 22554-8901
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Country | US
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Telephone | 571-409-9991
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Fax | 540-779-5033
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Provider Business Mailing Address
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Address Line | 245 GARRISONVILLE RD STE 102
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City | STAFFORD
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State | VA
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Zip | 22554-8901
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Country | US
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Telephone | 571-409-9991
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Fax | 540-779-5033
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Authorized Official
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Title or Position | CEO
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Name | AARON WORLANYO ODUM
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Credential |
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Telephone | 571-409-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 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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