MEDICARE: FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225400000X	Rehabilitation Practitioner
2	343900000X	Non-emergency Medical Transport (VAN)
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1053516344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	4343 PLANK RD STE 100
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-4807
Country	:	US
Telephone Number	:	540-907-4555
Fax Number	:	540-371-8446

Provider Business Practice Location Address
First Line	:	10514 WAKEMAN DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-8040
Country	:	US
Telephone Number	:	540-907-4555
Fax Number	:	540-371-8446

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOSEPH LYTTLE
Credential	:
Telephone Number	:	540-907-4555

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/30/2022

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