1447792080 NPI number — ANGELA JULIA LAWRENCE HOME HEALTH CARE

Table of content: ANGELA JULIA LAWRENCE HOME HEALTH CARE (NPI 1447792080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447792080 NPI number — ANGELA JULIA LAWRENCE HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
ANGELA
Provider Middle Name:
JULIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HOME HEALTH CARE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWRENCE
Provider Other First Name:
OWEN
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HOME HEALTH CARE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447792080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8032 MECHANICSVILLE TPKE
Provider Second Line Business Mailing Address:
8 032MECHANICSVILLE TURNPIKE
Provider Business Mailing Address City Name:
MECHANICSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23111-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-559-0322
Provider Business Mailing Address Fax Number:
804-559-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8032 MECHANICSVILLE TPKE
Provider Second Line Business Practice Location Address:
8032 MECHANICSVILLE TURNPIKE
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23111-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-559-0322
Provider Business Practice Location Address Fax Number:
804-559-0344
Provider Enumeration Date:
11/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  HCO17726 , 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: 1093042723 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com