TO THE MOON PLLC NPI 1861149510

NPI Information

NPI: 1861149510
Provider Name: TO THE MOON PLLC
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
3445 BERKELEY ST APT 242
ALEXANDRIA, VA
ZIP 22302
Phone: (804) 728-8882
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TO THE MOON PLLC is a community based residential treatment facility, intellectual and/or developmental disabilities in Alexandria, VA. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. TO THE MOON PLLC NPI is 1861149510. The provider is registered as an organization entity type.

The provider's business location address is:

3445 BERKELEY ST APT 242
ALEXANDRIA, VA
ZIP 22302-287
Phone: (804) 728-8882

The provider's authorized official is Lizna Khimani .
The authorized official title is Bcba and has the following contact phone number (804) 728-8827.

The enumeration date for this NPI number is 3/2/2022 and was last updated on 3/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD1600X	Clinic/Center	Developmental Disabilities			No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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