Healthcare Provider Details

I. General information

NPI: 1538583653
Provider Name (Legal Business Name): FERNELLAS QUALITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 24TH ROAD SOUTH #624
ARLINGTON VA
22206
US

IV. Provider business mailing address

2300 24TH ROAD SOUTH #624
ARLINGTON VA
22206
US

V. Phone/Fax

Practice location:
  • Phone: 571-435-5032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberR146754
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR146754
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberR146754
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberR146754
License Number State
# 5
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberR146754
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberR146754
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberR146754
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberR146754
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberR146754
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberR146754
License Number StateMD
# 11
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberR146754
License Number State
# 12
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberR146754
License Number StateMD
# 13
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberR146754
License Number StateMD
# 14
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberR146754
License Number StateMD
# 15
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberR146754
License Number State

VIII. Authorized Official

Name: BERNADETTE BENTA
Title or Position: CARE COORDINATION CONSULTANT
Credential: RN, MSHCA
Phone: 571-435-5032