Provider Demographics
NPI:1538583653
Name:FERNELLAS QUALITY CARE
Entity type:Organization
Organization Name:FERNELLAS QUALITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSHCA
Authorized Official - Phone:571-435-5032
Mailing Address - Street 1:2300 24TH ROAD SOUTH #624
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 24TH ROAD SOUTH #624
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206
Practice Address - Country:US
Practice Address - Phone:571-435-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R146754133N00000X, 261QA0005X, 302F00000X, 251B00000X
MDR146754251E00000X, 252Y00000X, 281P00000X, 281PC2000X, 282NC2000X, 291U00000X, 293D00000X, 302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No281P00000XHospitalsChronic Disease Hospital
No281PC2000XHospitalsChronic Disease HospitalChildren
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service