Provider Demographics
NPI:1538849773
Name:ANNA & RAPHAEL RESIDENTIAL SERVICES, LLC
Entity type:Organization
Organization Name:ANNA & RAPHAEL RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BIBIIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEONYIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-426-0447
Mailing Address - Street 1:6 PIDGEON HILL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6176
Mailing Address - Country:US
Mailing Address - Phone:571-209-0013
Mailing Address - Fax:571-313-0196
Practice Address - Street 1:13705 MAPLEDALE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4455
Practice Address - Country:US
Practice Address - Phone:571-209-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services