Provider Demographics
NPI:1932882503
Name:ROBERTSON'S HOMECARE AND RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:ROBERTSON'S HOMECARE AND RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FATU
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-380-8406
Mailing Address - Street 1:303 MARSHALLS VENTURE CT
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3347
Mailing Address - Country:US
Mailing Address - Phone:240-380-8406
Mailing Address - Fax:
Practice Address - Street 1:2000 N BEAUREGARD ST APT 115
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-4633
Practice Address - Country:US
Practice Address - Phone:703-991-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities