Organization
LILY ROSE RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIKATA KHYNE-SAM (DIRECTOR)
(703) 401-4133
Entity
Organization
Contact information
Practice address
3102 GOLANSKY BLVD STE 202, WOODBRIDGE, VA 22192-4244
(703) 401-4133
Mailing address
3102 GOLANSKY BLVD STE 202, WOODBRIDGE, VA 22192-4244
(703) 401-4133
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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