1366620486 NPI number — CARE ALTERNATIVES OF VIRGINIA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366620486 NPI number — CARE ALTERNATIVES OF VIRGINIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE ALTERNATIVES OF VIRGINIA LLC
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:
6
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:
1366620486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 JACKSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07016-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-931-9068
Provider Business Mailing Address Fax Number:
908-931-9698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10571 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23059-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-673-1330
Provider Business Practice Location Address Fax Number:
804-673-2778
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EFODILI
Authorized Official First Name:
YEWANDE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
908-931-9080

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HSP-09151 , 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: 1366620486 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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