Lily Rose Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

LILY ROSE RESIDENTIAL SERVICES LLC

Practice address

3102 Golansky Blvd Ste 202
Woodbridge, VA 22192-4244

Phone

(703) 401-4133

NPI assigned

Aug 25, 2021

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

Director

Phone

(703) 401-4133

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1992472120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 GOLANSKY BLVD STE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924244",
            "telephone_number": "703-401-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 GOLANSKY BLVD STE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924244",
            "telephone_number": "703-401-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY ROSE RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "KHYNE-SAM",
        "authorized_official_first_name": "CHIKATA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-401-4133"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.