Organization
REVAMP SUPPORT RESIDENTIAL SERVICES LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STRAFFORD ACHANYI NGOSONG (PROGRAM DIRECTOR)
(202) 820-6698
Entity
Organization
Contact information
Practice address
2851 HEADWAY DR, WOODBRIDGE, VA 22191-6042
(202) 820-6698
Mailing address
2851 HEADWAY DR, WOODBRIDGE, VA 22191-6042
(202) 820-6698
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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