Provider Demographics
NPI:1295433969
Name:PETIT'S HALO, LLC
Entity type:Organization
Organization Name:PETIT'S HALO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-317-6267
Mailing Address - Street 1:10 WINDRUSH CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-5446
Mailing Address - Country:US
Mailing Address - Phone:540-317-6267
Mailing Address - Fax:
Practice Address - Street 1:714 HOPE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5226
Practice Address - Country:US
Practice Address - Phone:540-317-6267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities