Aa Mother LLC

NPI #1962190801 in Triangle, Virginia

Provider Information

NPI Number: 1962190801
Entity Type: Organization
Organization Name: Aa Mother LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Apr 28, 2023
Last Updated: Apr 28, 2023

Practice Location

Address: 19004 QUEEN DR
City: Triangle
State: Virginia
ZIP Code: 22172-2119
Phone: (240) 752-3568

Authorized Official

Name: HENRIETTE POUATENE
Title: ADMINISTRATOR
Phone: (240) 752-3568

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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