Healthcare Provider Details

I. General information

NPI: 1285132571
Provider Name (Legal Business Name): CITY OF ALEXANDRIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 JEFFERSON ST
ALEXANDRIA VA
22314-3924
US

IV. Provider business mailing address

1108 JEFFERSON ST
ALEXANDRIA VA
22314-3924
US

V. Phone/Fax

Practice location:
  • Phone: 703-746-5676
  • Fax:
Mailing address:
  • Phone: 703-746-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: DARRELL WESLEY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 703-746-5676