| Emd Group Home, Llc | |
|
15113 Holleyside Dr Montclair VA 22025-1050 | |
| (571) 295-1350 | |
| Not Available |
| Full Name | Emd Group Home, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 15113 Holleyside Dr, Montclair, Virginia |
| Authorized Official Name and Position | Maryse Isambo (CEO) |
| Authorized Official Contact | 5712951350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Emd Group Home, Llc 15113 Holleyside Dr Montclair VA 22025-1050 Ph: (571) 295-1350 | Emd Group Home, Llc 15113 Holleyside Dr Montclair VA 22025-1050 Ph: (571) 295-1350 |
| NPI Number | 1164008777 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164008777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Soto Executive Enterprise, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5227 Spring Branch Blvd, Montclair, VA 22025 Phone: 571-288-3440 |