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General NPI Number Information
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NPI Number | 1942490586
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIVING ALTERNATIVES - ICF
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 4123 CONRAD RD (FORMERLY COURHOUSE ROAD ICF)
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1155
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Country | US
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Telephone | 703-352-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 9401 LEE HWY #406
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City | FAIRFAX
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State | VA
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Zip | 22031-1849
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Country | US
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Telephone | 703-352-0388
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SILVA BEY
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Credential |
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Telephone | 703-352-0388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 08502006
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License Number State | VA
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