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General NPI Number Information
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NPI Number | 1659806545
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Entity Type | Organization
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Legal Business Name | MILESTONE GROUP HOMES & NURSING
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 9014 ORANGE HUNT LN
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City | ANNANDALE
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State | VA
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Zip | 22003-4126
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Country | US
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Telephone | 703-869-1120
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Fax | 187-725-2103
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Provider Business Mailing Address
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Address Line | 9014 ORANGE HUNT LN
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City | ANNANDALE
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State | VA
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Zip | 22003-4126
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Country | US
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Telephone | 703-869-1120
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Fax | 187-725-2103
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PATRICE T. NOUWEZEM
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Credential |
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Telephone | 70386911220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2573
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License Number State | VA
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