Provider Demographics
NPI:1942800594
Name:E & E RESIDENTIAL SUPPORT PROFESSIONALS LLC
Entity Type:Organization
Organization Name:E & E RESIDENTIAL SUPPORT PROFESSIONALS LLC
Other - Org Name:E & E RESIDENTIAL SUPPORT PROFESSIONALS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KWEKU
Authorized Official - Last Name:BANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-484-6464
Mailing Address - Street 1:15337 BARNABAS TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5566
Mailing Address - Country:US
Mailing Address - Phone:571-484-6464
Mailing Address - Fax:
Practice Address - Street 1:14221 LINDENDALE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3448
Practice Address - Country:US
Practice Address - Phone:571-484-6464
Practice Address - Fax:703-986-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities