Organization
ISU COTTAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERTA BANYONG (OWNER)
(240) 643-1517
Entity
Organization
Contact information
Practice address
9335 ROUTE 29 APT 212, FAIRFAX, VA 22031-1828
(240) 643-1517
Mailing address
10390 SWIFT STREAM PL APT 305, COLUMBIA, MD 21044-4867
(240) 643-1517
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/04/2025
Last updated
07/04/2025
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