Organization
1ST PROMISE RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERDINAND ATABONGAWUNG (OWNER)
(571) 278-1273
Entity
Organization
Contact information
Practice address
10127 WOODBURY DR APT 512, MANASSAS, VA 20109-3781
(571) 278-1273
Mailing address
10127 WOODBURY DR APT 512, MANASSAS, VA 20109-3781
(571) 278-1273
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3979
—
VA
Enumeration date
12/10/2021
Last updated
12/10/2021
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