Provider Demographics
NPI:1770527160
Name:LANGLEY RESIDENTIAL SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:LANGLEY RESIDENTIAL SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:SCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-893-0068
Mailing Address - Street 1:1487 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5723
Mailing Address - Country:US
Mailing Address - Phone:703-893-0068
Mailing Address - Fax:703-893-5047
Practice Address - Street 1:1487 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5723
Practice Address - Country:US
Practice Address - Phone:703-893-0068
Practice Address - Fax:703-893-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA061320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061OtherSTATE LICENSE