Emd Group Home, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EMD GROUP HOME, LLC

Practice address

15113 Holleyside Dr
Montclair, VA 22025-1050

Phone

(571) 295-1350

NPI assigned

Mar 23, 2021

Last updated

Mar 23, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maryse Isambo

Title

Ceo

Phone

(571) 295-1350

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1164008777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15113 HOLLEYSIDE DR",
            "city": "MONTCLAIR",
            "state": "VA",
            "postal_code": "220251050",
            "telephone_number": "571-295-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15113 HOLLEYSIDE DR",
            "city": "MONTCLAIR",
            "state": "VA",
            "postal_code": "220251050",
            "telephone_number": "571-295-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMD GROUP HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "ISAMBO",
        "authorized_official_first_name": "MARYSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "571-295-1350"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "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 Mar 23, 2021; 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.