# ALTERNATIVE LIVING RESIDENCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316711948
- **Authorized official:** LYDIA T JANNAH (OWNER)
- **Authorized official phone:** (571) 477-8097

## Contact information

- **Practice address:** 14090 BIG CREST LN APT 207, WOODBRIDGE, VA 22191-5531
- **Practice address phone:** (157) 477-8097
- **Mailing address:** 4 FLEWELLEN DR, STAFFORD, VA 22554-7829
- **Mailing address phone:** (571) 477-8097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/14/2023
- **Last updated:** 02/23/2024