Organization
GOODWILL HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER E LEYOU (DIRECTOR)
(202) 258-3344
Entity
Organization
Contact information
Practice address
13126 MERCURY LN, FAIRFAX, VA 22033-3711
(202) 258-3344
Mailing address
13126 MERCURY LN, FAIRFAX, VA 22033-3711
(202) 258-3344
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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