MEDICARE: CITAGROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346935806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITAGROUP LLC

Provider Business Mailing Address
First Line	:	13355 CASTLEWELLAN DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-2904
Country	:	US
Telephone Number	:	804-720-5164
Fax Number	:

Provider Business Practice Location Address
First Line	:	13355 CASTLEWELLAN DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-2904
Country	:	US
Telephone Number	:	804-720-5164
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. YINKA T LAWAL
Credential	:
Telephone Number	:	804-720-5164

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	11/26/2024

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Directions to “CITAGROUP LLC ” Practice Location

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