Provider Demographics
NPI:1538569223
Name:VIRGINIA HEALTHCARE SERVICES OF FREDERICKSBURG, LLC
Entity type:Organization
Organization Name:VIRGINIA HEALTHCARE SERVICES OF FREDERICKSBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:SALE
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:540-369-8322
Mailing Address - Street 1:3042 VALLEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2669
Mailing Address - Country:US
Mailing Address - Phone:540-369-8322
Mailing Address - Fax:540-662-5338
Practice Address - Street 1:3042 VALLEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2669
Practice Address - Country:US
Practice Address - Phone:540-369-8322
Practice Address - Fax:540-662-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-11696251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497669Medicare Oscar/Certification