Provider Demographics
NPI:1306593256
Name:ROBISAN ADULT GROUP HOME LLC
Entity type:Organization
Organization Name:ROBISAN ADULT GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ABIGAIL
Authorized Official - Last Name:ROBERTSON-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CRNA
Authorized Official - Phone:301-922-6802
Mailing Address - Street 1:2112 THOMPSON HILL CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4354
Mailing Address - Country:US
Mailing Address - Phone:301-922-6802
Mailing Address - Fax:
Practice Address - Street 1:8443 BATES DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4478
Practice Address - Country:US
Practice Address - Phone:301-922-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW21049879OtherMARYLAND LLC