Provider Demographics
NPI:1609410273
Name:HANDS OF MERCY GROUP HOME LLC
Entity Type:Organization
Organization Name:HANDS OF MERCY GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FADUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-338-2684
Mailing Address - Street 1:10560 MAIN ST STE 406
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7174
Mailing Address - Country:US
Mailing Address - Phone:703-635-3306
Mailing Address - Fax:703-830-3699
Practice Address - Street 1:12783 CRUZ CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7283
Practice Address - Country:US
Practice Address - Phone:703-635-3306
Practice Address - Fax:703-830-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities