Provider Demographics
NPI:1649670118
Name:ASSURED DEVELOPMENT SERVICES LLC.
Entity type:Organization
Organization Name:ASSURED DEVELOPMENT SERVICES LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURGO
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP, MED
Authorized Official - Phone:804-218-9300
Mailing Address - Street 1:5930 OSOGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2529
Mailing Address - Country:US
Mailing Address - Phone:804-218-9300
Mailing Address - Fax:
Practice Address - Street 1:5930 OSOGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2529
Practice Address - Country:US
Practice Address - Phone:804-218-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA187801001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities