Provider Demographics
NPI:1730161365
Name:FC OF VIRGINIA INC
Entity type:Organization
Organization Name:FC OF VIRGINIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:4055 VALLEY VIEW LN
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5074
Mailing Address - Country:US
Mailing Address - Phone:214-445-3750
Mailing Address - Fax:214-445-3902
Practice Address - Street 1:106 ROWE RD
Practice Address - Street 2:#103
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-6714
Practice Address - Country:US
Practice Address - Phone:540-886-0342
Practice Address - Fax:540-886-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010093724Medicaid
VA497292Medicare Oscar/Certification