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General NPI Number Information
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NPI Number | 1609410273
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Entity Type | Organization
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Legal Business Name | HANDS OF MERCY GROUP HOME LLC
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 12783 CRUZ CT
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City | FAIRFAX
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State | VA
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Zip | 22030-7283
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Country | US
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Telephone | 703-635-3306
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Fax | 703-830-3699
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Provider Business Mailing Address
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Address Line | 10560 MAIN ST STE 406
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City | FAIRFAX
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State | VA
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Zip | 22030-7174
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Country | US
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Telephone | 703-635-3306
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Fax | 703-830-3699
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Authorized Official
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Title or Position | CEO
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Name | FADUMA HUSSEIN
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Credential |
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Telephone | 571-338-2684
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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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