Organization
IMAGO DEI SUPPORT SERVICES. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICTORIA A GBADEBO REGISTERED NURSE (PROGRAM DIRECTOR)
(804) 218-2595
Entity
Organization
Contact information
Practice address
12531 CLIPPER DR STE 101, WOODBRIDGE, VA 22192-2355
(571) 427-2710
(804) 714-0023
Mailing address
12531 CLIPPER DR STE 101, WOODBRIDGE, VA 22192-2355
(804) 218-2595
(804) 714-0023
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
04/09/2024
Last updated
04/09/2024
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