HOME AWAY RESIDENTIAL SERVICES LLC (NPI# 1164076790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164076790 |
| Entity Type | Organization |
| Organization Name | HOME AWAY RESIDENTIAL SERVICES LLC |
| Practice Address |
4304 Eldorado Dr Woodbridge VA 22193-2716 |
| Practice Telephone | 3018076184 |
| Practice Fax Number | 3014640225 |
| Mailing Telephone | 3018076184 |
| Mailing Fax Number | 3014640225 |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |
| Authorized Official Name | MR. NKENGLEFE FELIX ATANGCHO (OWNER) |
| Authorized Official Telephone | 3018076184 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Home away Residential services LLC | Former Legal Business Name - Organization |
| Street Address |
4304 ELDORADO DR |
| City | WOODBRIDGE |
| State | VA |
| Zip Code | 22193-2716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083111702 | Bethiana Magallanes White | Speech-Language Pathologist | 14450 Brook Dr, Woodbridge, VA 22193 | 2018-04-09 |
| 1982111449 | Frances Davis | Social Worker | 4196 Merchant Plaza Apt 632, Woodbridge, VA 22193 | 2018-01-05 |
| 1427421627 | Woodbridge Therapy Group LLC | Counselor | 12721 Darby Brooke Ct., Suite 102, Woodbridge, VA 22193 | 2015-11-10 |
| 1972981090 | Lifeline Home Health Inc | Community/Behavioral Health | 4309 Kenwood Dr, Woodbridge, VA 22193 | 2015-05-08 |
| 1588056139 | Lifelong Good Health LLC | Clinic/Center | 5721 Rhode Isalnd Drive, Woodbridge, VA 22193 | 2015-02-19 |
| 1639560378 | Tara Devi Smith | Psychologist | 13855 Hedgewood Drive, #245, Woodbridge, VA 22193 | 2015-02-17 |
| 1710396114 | Allanna Harrison | Speech-Language Pathologist | 15792 Beau Ridge Dr., Woodbridge, VA 22193 | 2014-08-11 |
| 1659788909 | Lifelong Good Health | Clinic/Center | 5721 Rhode Island Dr, Woodbridge, VA 22193 | 2014-07-18 |
| 1952731960 | Corrieann Marie Avila | Social Worker | 12721 Darby Brooke Court, Suite 102, Woodbridge, VA 22193 | 2013-11-13 |
| 1972881019 | Ockhee Jung | Acupuncturist | 14174 Rizdon Ct, Woodbridge, VA 22193 | 2011-07-22 |
| Find all providers in zip 22193 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891327417 | Perfect Home Support, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13662 Office Pl Ste 104, Woodbridge, VA 22192-4217 | 2020-02-11 |
| 1831755958 | Blessed Support Professionals, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 14511 Jefferson Davis Hwy # A, Woodbridge, VA 22191-2807 | 2019-05-14 |
| 1588229306 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Ave, Apt 103, Woodbridge, NJ 07001 | 2019-05-07 |
| 1942800594 | E & E Residential Support Professionals LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15337 Barnabas Trl, Woodbridge, VA 22193-5566 | 2020-10-30 |
| 1871113936 | Applied Group Home Solutions LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1986 Opitz Blvd, Woodbridge, VA 22191-3304 | 2020-04-19 |
| 1740834068 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Avenue, Apt 227, Woodbridge, NJ 17001-0850 | 2019-07-25 |
| 1285288688 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Avenue, Apt. 106, Woodbridge, NJ 17001 | 2019-07-25 |
| 1689227019 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Avenue, Apt 117, Woodbridge, NJ 17001-0850 | 2019-07-24 |
| 1497308829 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Avenue, Apt 113, Woodbridge, NJ 08501-0850 | 2019-07-24 |
| 1790338119 | Pennreach | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1482 Rahway Avenue, 104, Woodbridge, NJ 17001-0850 | 2019-07-24 |
| Find all providers in WOODBRIDGE | ||||
| City | WOODBRIDGE |
| Zip Code | 22193 |
Please comment or provide details below to improve the information on HOME AWAY RESIDENTIAL SERVICES LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.