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General NPI Number Information
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NPI Number | 1871058404
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Entity Type | Organization
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Legal Business Name | PEACEFUL LIVING HOME
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 6221 OSCAR CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7024
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Country | US
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Telephone | 703-223-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 OSCAR CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MABINTI KAMARA
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Credential |
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Telephone | 703-223-3911
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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 |
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License Number State |
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