Provider Demographics
NPI:1568575223
Name:DANA'S HABITAT, INC..
Entity Type:Organization
Organization Name:DANA'S HABITAT, INC..
Other - Org Name:UNIQUE LESSON LEARNING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:CONSTANCE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:804-329-4600
Mailing Address - Street 1:2325 THOUSAND OAKS DR
Mailing Address - Street 2:DANA'S HABITAT, INC.
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3433
Mailing Address - Country:US
Mailing Address - Phone:804-901-9060
Mailing Address - Fax:804-249-6960
Practice Address - Street 1:10401 DURYEA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1709
Practice Address - Country:US
Practice Address - Phone:804-216-0906
Practice Address - Fax:804-249-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA643-01-001320600000X
VA64301001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010066531Medicaid