Provider Demographics
NPI:1700661048
Name:DIGNITY GROUP HOMES LLC
Entity type:Organization
Organization Name:DIGNITY GROUP HOMES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NGAHYOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-330-0046
Mailing Address - Street 1:12035 N DICKINSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6579
Mailing Address - Country:US
Mailing Address - Phone:571-565-3192
Mailing Address - Fax:
Practice Address - Street 1:12035 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6579
Practice Address - Country:US
Practice Address - Phone:571-565-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities