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General NPI Number Information
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NPI Number | 1649055849
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Entity Type | Organization
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Legal Business Name | LA MAZON TRAINING CENTER INCORPORATED
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 1418 IDAHO ST
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3706
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Country | US
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Telephone | 571-201-3317
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Fax | 866-985-4040
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Provider Business Mailing Address
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Address Line | 9515 EREDINE WAY
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City | BRISTOW
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State | VA
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Zip | 20136-3517
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Country | US
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Telephone | 571-201-3317
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | GENEVIEVE KOFIE
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Credential |
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Telephone | 571-201-3317
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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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