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General NPI Number Information
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NPI Number | 1780187757
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Entity Type | Organization
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Legal Business Name | ESTHER'S HOME LLC
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 3302 CAMPBELL DR
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1108
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Country | US
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Telephone | 703-623-5275
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 CAMPBELL DR
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1108
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Country | US
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Telephone | 703-623-5275
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JIMMY ABEL BERNARDEZ
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Credential |
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Telephone | 703-623-5275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 2442-01-001
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License Number State | VA
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