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General NPI Number Information
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NPI Number | 1851056360
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Entity Type | Organization
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Legal Business Name | ROYAL GROUP HOME, LLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 6024 STODDARD CT APT 202
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5612
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Country | US
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Telephone | 703-786-0891
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Fax | 703-594-8532
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Provider Business Mailing Address
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Address Line | 6024 STODDARD CT APT 202
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5612
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Country | US
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Telephone | 703-786-0891
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Fax | 703-594-8532
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Authorized Official
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Title or Position | CEO
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Name | MR. SINTAYEHU ABEBE
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Credential |
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Telephone | 703-786-0891
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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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