Provider Demographics
NPI:1689834509
Name:DATLA SERVICES, INC.
Entity Type:Organization
Organization Name:DATLA SERVICES, INC.
Other - Org Name:SILVER SPRING ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SREEDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:DATLA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:240-793-6052
Mailing Address - Street 1:2305 FALLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5208
Mailing Address - Country:US
Mailing Address - Phone:301-384-8729
Mailing Address - Fax:301-476-7544
Practice Address - Street 1:2305 FALLING CREEK RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5208
Practice Address - Country:US
Practice Address - Phone:301-384-8729
Practice Address - Fax:301-476-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL0580310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility