=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942928189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAA RESIDENCIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2022
-----------------------------------------------------
Last Update Date | 09/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5814 TILBURY ROAD
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-220-9499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6094 FRANCONIA RD STE A
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-220-9499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. PAWAN K GUPTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-220-9499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------