Provider Demographics
NPI:1972370237
Name:THE CHANCELLOR GROUP HOME LLC
Entity Type:Organization
Organization Name:THE CHANCELLOR GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-615-1189
Mailing Address - Street 1:23096 FONTWELL SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4348
Mailing Address - Country:US
Mailing Address - Phone:202-615-1189
Mailing Address - Fax:
Practice Address - Street 1:23096 FONTWELL SQ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4348
Practice Address - Country:US
Practice Address - Phone:202-615-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities