Provider Demographics
NPI:1750652764
Name:ALTERNATIVE HOUSE - THE ABUSED AND HOMELESS CHILDREN'S REFUGE
Entity type:Organization
Organization Name:ALTERNATIVE HOUSE - THE ABUSED AND HOMELESS CHILDREN'S REFUGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-506-9191
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-0694
Mailing Address - Country:US
Mailing Address - Phone:703-506-9191
Mailing Address - Fax:703-506-8949
Practice Address - Street 1:2100 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3910
Practice Address - Country:US
Practice Address - Phone:703-506-9191
Practice Address - Fax:703-506-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health