Lily Rose Residential Services-DC Inc

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

LILY ROSE RESIDENTIAL SERVICES-DC INC

Practice address

3516 Plank Rd Ste 5C
Fredericksburg, VA 22407-6861

Phone

(703) 407-1011

NPI assigned

Sep 23, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chikata Khyne-Sam

Title

Administrator

Phone

(703) 407-1011

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1023835998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3516 PLANK RD STE 5C",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224076861",
            "telephone_number": "703-407-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3516 PLANK RD STE 5C",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224076861",
            "telephone_number": "703-407-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY ROSE RESIDENTIAL SERVICES-DC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "KHYNE-SAM",
        "authorized_official_first_name": "CHIKATA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-407-1011"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.