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General NPI Number Information
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NPI Number | 1538849773
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Entity Type | Organization
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Legal Business Name | ANNA & RAPHAEL RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 13705 MAPLEDALE AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4455
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Country | US
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Telephone | 571-209-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 6 PIDGEON HILL DR STE 240
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City | STERLING
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State | VA
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Zip | 20165-6176
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Country | US
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Telephone | 571-209-0013
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Fax | 571-313-0196
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BIBIIANA EZEONYIM
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Credential |
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Telephone | 240-426-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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