Organization
DRAGONFLYTE ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW JOSEPH JAEGER MD (CEO/DIRECTOR)
(804) 854-4211
Entity
Organization
Contact information
Practice address
108 MASONS COVE LN, TOPPING, VA 23169-2176
(804) 758-2122
Mailing address
108 MASONS COVE LN, TOPPING, VA 23169-2176
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010221617VA
—
VA
Enumeration date
05/15/2013
Last updated
05/15/2013
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