NPI 1285957761

Provident Arc LLC

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Woodbridge, VA

Practice location

Address: 17300 River Ridge Blvd Suite 301, Woodbridge, VA 22191-5167
Phone: (703) 861-4409

Authorised official

Name: Reynaldo Roundtree
Title: Co-Owner
Phone: (703) 861-4409

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 954 (VA)

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Registry record

NPI: 1285957761
Entity type: Organization
NPI issued: 11 Mar 2010
Record last updated: 11 Mar 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.