1225331317 NPI number — VIRGINIA CENTER FOR HEALTH AND WELLNESS, 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 1225331317 NPI number — VIRGINIA CENTER FOR HEALTH AND WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA CENTER FOR HEALTH AND WELLNESS, 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:
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:
1225331317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 CLAIBORNE SQ E
Provider Second Line Business Mailing Address:
220
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-926-0568
Provider Business Mailing Address Fax Number:
757-838-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 CLAIBORNE SQ E
Provider Second Line Business Practice Location Address:
220
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-926-0568
Provider Business Practice Location Address Fax Number:
757-838-1895
Provider Enumeration Date:
12/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOSKOWITZ
Authorized Official First Name:
JONINA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
757-926-0568

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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