Healthcare Provider Details

I. General information

NPI: 1104365642
Provider Name (Legal Business Name): ARLINGTON COUNTY GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 16TH ST S
ARLINGTON VA
22204-4974
US

IV. Provider business mailing address

2909 16TH ST S
ARLINGTON VA
22204-4974
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5340
  • Fax:
Mailing address:
  • Phone: 703-228-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC113670-L155
License Number StateVA

VIII. Authorized Official

Name: MICHAEL DIGERONIMO
Title or Position: DIRECTOR
Credential: CTRS
Phone: 703-228-5340