Imago Dei Support Services. LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

IMAGO DEI SUPPORT SERVICES. LLC

Practice address

12531 Clipper Dr Ste 101
Woodbridge, VA 22192-2355

Phone

(571) 427-2710

Fax

(804) 714-0023

NPI assigned

Apr 9, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Victoria A Gbadebo, REGISTERED NURSE

Title

Program Director

Phone

(804) 218-2595

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1700639770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12531 CLIPPER DR STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922355",
            "telephone_number": "804-218-2595",
            "fax_number": "804-714-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12531 CLIPPER DR STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922355",
            "telephone_number": "571-427-2710",
            "fax_number": "804-714-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGO DEI SUPPORT SERVICES. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "GBADEBO",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "804-218-2595",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Developmentally Disabled Services Day Training Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.