1306252804 NPI number — COMMUNITY ALTERNATIVES VIRGINIA, INC.

Table of content: BRITTANY RENEE FUGATE HHA (NPI 1881120541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306252804 NPI number — COMMUNITY ALTERNATIVES VIRGINIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ALTERNATIVES VIRGINIA, INC.
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:
1306252804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-5186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 QUINN WEST STUART BLVD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24073-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-381-3940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MATTINGLY
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR PROVIDER ENROLLMENT
Authorized Official Telephone Number:
502-630-7425

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)





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