Provider Demographics
NPI:1801580501
Name:DREAMSVILLE RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:DREAMSVILLE RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/ QDDP
Authorized Official - Prefix:
Authorized Official - First Name:RAHEL
Authorized Official - Middle Name:TAYE
Authorized Official - Last Name:WOLDESMAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-232-9179
Mailing Address - Street 1:3656 STONEWALL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-1431
Mailing Address - Country:US
Mailing Address - Phone:571-232-9172
Mailing Address - Fax:
Practice Address - Street 1:3656 STONEWALL MANOR DR
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-1431
Practice Address - Country:US
Practice Address - Phone:571-232-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services