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Organization

PROVIDENT ARC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
REYNALDO ROUNDTREE (CO-OWNER)
(703) 861-4409
Entity
Organization

Contact information

Practice address
17300 RIVER RIDGE BLVD, SUITE 301, WOODBRIDGE, VA 22191-5167
(703) 861-4409
Mailing address
17300 RIVER RIDGE BLVD, SUITE 301, WOODBRIDGE, VA 22191-5167
(703) 861-4409

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
954
VA

Other

Enumeration date
03/11/2010
Last updated
03/11/2010
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