Provider Demographics
NPI:1346718814
Name:CANAAN CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CANAAN CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATCHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-432-8864
Mailing Address - Street 1:20322 TANAGER PL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8892
Mailing Address - Country:US
Mailing Address - Phone:571-432-8864
Mailing Address - Fax:703-348-7510
Practice Address - Street 1:10066 MARSHALL POND RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3731
Practice Address - Country:US
Practice Address - Phone:571-432-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities