Healthcare Provider Details

I. General information

NPI: 1831574078
Provider Name (Legal Business Name): TWENTY PACK MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 WILSON BLVD
ARLINGTON VA
22205-1548
US

IV. Provider business mailing address

5900 WILSON BLVD
ARLINGTON VA
22205-1548
US

V. Phone/Fax

Practice location:
  • Phone: 703-536-1060
  • Fax: 703-444-8294
Mailing address:
  • Phone: 703-536-1060
  • Fax: 703-444-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberBLC-1000030930-05
License Number StateVA

VIII. Authorized Official

Name: RAYMOND DENNISON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 703-536-1060