Healthcare Provider Details

I. General information

NPI: 1548499304
Provider Name (Legal Business Name): UNITED METHODIST FAMILY SERVICES OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 SHAWNEE RD SUITE 101
ALEXANDRIA VA
22312-2300
US

IV. Provider business mailing address

3900 W BROAD ST BUILDING 10
RICHMOND VA
23230-3958
US

V. Phone/Fax

Practice location:
  • Phone: 703-941-9008
  • Fax: 703-750-0621
Mailing address:
  • Phone: 804-353-4461
  • Fax: 804-239-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number03205376
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number19305001
License Number StateVA

VIII. Authorized Official

Name: MRS. MARCY JOHNSON
Title or Position: VICE PRESIDENT OF PROGRAMS
Credential:
Phone: 804-353-4461