Provider Demographics
NPI:1689223224
Name:EVEREADY RESIDENTIAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:EVEREADY RESIDENTIAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:703-496-4300
Mailing Address - Street 1:14240 SPRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3610
Mailing Address - Country:US
Mailing Address - Phone:703-496-4300
Mailing Address - Fax:855-256-4003
Practice Address - Street 1:14240 SPRIGGS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3610
Practice Address - Country:US
Practice Address - Phone:703-496-4300
Practice Address - Fax:855-256-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities