Provider Demographics
NPI:1538783634
Name:HCP WILSON BLVD. VA OPCO, LLC
Entity type:Organization
Organization Name:HCP WILSON BLVD. VA OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-536-1060
Mailing Address - Street 1:5910 WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1554
Mailing Address - Country:US
Mailing Address - Phone:703-536-1060
Mailing Address - Fax:703-444-8294
Practice Address - Street 1:5910 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-1554
Practice Address - Country:US
Practice Address - Phone:703-536-1060
Practice Address - Fax:703-444-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility