Organization
AURUM PROVIDENCE LLC
Active
Other names
Aurum Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAEKSOO LEE (CEO)
(703) 899-6774
Entity
Organization
Contact information
Practice address
4406 TULIP TREE CT, CHANTILLY, VA 20151-2441
(703) 899-6774
Mailing address
4371 STRAWFLOWER ST, FAIRFAX, VA 22030-5781
(703) 899-6774
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/18/2025
Last updated
01/02/2026
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