Provider Demographics
NPI:1629602891
Name:THE GATES OF BEAUTIFUL LLC
Entity Type:Organization
Organization Name:THE GATES OF BEAUTIFUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ARANGU
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:NGUNDAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-275-7045
Mailing Address - Street 1:7839 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2883
Mailing Address - Country:US
Mailing Address - Phone:571-275-7045
Mailing Address - Fax:571-208-0513
Practice Address - Street 1:7839 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2883
Practice Address - Country:US
Practice Address - Phone:571-275-7045
Practice Address - Fax:571-208-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3252OtherDEPARTMENT OF BAHAVIORAL HEALTH AND DISABILITIES