Organization
POTTER'S GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABA ADUSEI (CEO/PROGRAM DIRECTOR)
(571) 477-8172
Entity
Organization
Contact information
Practice address
3641 DAHLGREN PLACE, DUMFRIES, VA 22026-2602
(571) 477-8172
(703) 221-9746
Mailing address
3641 DAHLGREN PLACE, DUMFRIES, VA 22026-2602
(571) 477-8172
(703) 221-9746
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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