Provider Demographics
NPI:1982462149
Name:ROSA VILLOSA RESIDENTIAL HOME LLC
Entity type:Organization
Organization Name:ROSA VILLOSA RESIDENTIAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DANKWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-275-8914
Mailing Address - Street 1:105 CATES LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3364
Mailing Address - Country:US
Mailing Address - Phone:571-275-8991
Mailing Address - Fax:
Practice Address - Street 1:2 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2794
Practice Address - Country:US
Practice Address - Phone:571-275-8914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness