1972699346 NPI number — FAMILY CARE CENTER INC

Table of content: (NPI 1972699346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972699346 NPI number — FAMILY CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE CENTER 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:
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:
1972699346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21556D TIMBERLAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-7234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-239-8104
Provider Business Mailing Address Fax Number:
434-239-4312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21556D TIMBERLAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-7234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-239-8104
Provider Business Practice Location Address Fax Number:
434-239-4312
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
434-239-8104

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101040584 , 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: 1679667174 . This is a "NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 197594 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: F2012 . This is a "RAILROAD GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C01732 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 035241 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205921210 . This is a "NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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