# VIRGINIA RECOVERY LIVING CORPORATION

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

## Provider details

- **NPI number:** 1528915998
- **Authorized official:** PHANTA JAH (CO-OWNER)
- **Authorized official phone:** (540) 254-0877

## Contact information

- **Practice address:** 3130 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4268
- **Practice address phone:** (540) 254-0877
- **Practice address fax:** (703) 649-0129
- **Mailing address:** 3130 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4268
- **Mailing address phone:** (540) 254-0877
- **Mailing address fax:** (703) 649-0129

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251F00000X | Home Infusion Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 253J00000X | Foster Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/13/2026
- **Last updated:** 03/13/2026