Provider Demographics
NPI:1821813668
Name:OBG HOME LIFE SOLUTIONS LLC
Entity type:Organization
Organization Name:OBG HOME LIFE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DIR OF RESIDENTIAL PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:O
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-533-1199
Mailing Address - Street 1:5618 GALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3227
Mailing Address - Country:US
Mailing Address - Phone:240-533-1199
Mailing Address - Fax:
Practice Address - Street 1:615 SWANN AVE APT 106
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1451
Practice Address - Country:US
Practice Address - Phone:703-299-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services