Provider Demographics
NPI:1265580831
Name:HAYNESVIEW LLC
Entity type:Organization
Organization Name:HAYNESVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LABRENDA
Authorized Official - Middle Name:HURST
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:BS RN
Authorized Official - Phone:703-398-9840
Mailing Address - Street 1:6215 ALISTAIR DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3460
Mailing Address - Country:US
Mailing Address - Phone:703-398-9840
Mailing Address - Fax:703-580-1725
Practice Address - Street 1:4502 HANOVER CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4712
Practice Address - Country:US
Practice Address - Phone:703-398-9840
Practice Address - Fax:703-580-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
VA860251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services