Home Away Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

HOME AWAY RESIDENTIAL SERVICES LLC

Practice address

4304 Eldorado Dr
Woodbridge, VA 22193-2716

Phone

(301) 807-6184

Fax

(301) 464-0225

NPI assigned

Jul 31, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Nkenglefe Felix Atangcho

Title

Owner

Phone

(301) 807-6184

Specialties & licenses 1

Addresses

Other names 1

• Home away Residential services LLC Former legal business name

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1164076790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 ELDORADO DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932716",
            "telephone_number": "301-807-6184",
            "fax_number": "301-464-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4304 ELDORADO DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932716",
            "telephone_number": "301-807-6184",
            "fax_number": "301-464-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME AWAY RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "ATANGCHO",
        "authorized_official_first_name": "NKENGLEFE",
        "authorized_official_middle_name": "FELIX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-807-6184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Home away Residential services LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.