Organization
DIDLAKE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA J HOLLIS (CHIEF FINANCIAL OFFICER)
(703) 361-4195
Entity
Organization
Contact information
Practice address
8621 BREEDEN AVE, MANASSAS, VA 20110-8413
(703) 361-4195
(703) 369-2719
Mailing address
8641 BREEDEN AVE, MANASSAS, VA 20110-8431
(703) 361-4195
(703) 369-2719
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
12002006
VA
Other
Enumeration date
03/14/2006
Last updated
08/22/2020
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