1245297506 NPI number — ALEXANDRIA GERIATRIC CARE

Table of content: (NPI 1245297506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245297506 NPI number — ALEXANDRIA GERIATRIC CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDRIA GERIATRIC CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245297506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22066-0641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-759-2724
Provider Business Mailing Address Fax Number:
703-759-2724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10006 THOMPSON RIDGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-759-6294
Provider Business Practice Location Address Fax Number:
703-759-2724
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALCZAK
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
703-759-2724

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101033583 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5872936 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G3900001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".