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General NPI Number Information
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NPI Number | 1821813668
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Entity Type | Organization
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Legal Business Name | OBG HOME LIFE SOLUTIONS LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 615 SWANN AVE APT 106
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City | ALEXANDRIA
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State | VA
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Zip | 22301-1451
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Country | US
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Telephone | 703-299-2489
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Fax |
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Provider Business Mailing Address
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Address Line | 5618 GALLOWAY DR
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City | OXON HILL
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State | MD
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Zip | 20745-3227
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Country | US
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Telephone | 240-533-1199
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Fax |
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Authorized Official
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Title or Position | MEMBER/DIR OF RESIDENTIAL PROGRAMS
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Name | MS. CRYSTAL O GASTON
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Credential |
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Telephone | 240-533-1199
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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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