Healthcare Provider Details

I. General information

NPI: 1366208829
Provider Name (Legal Business Name): FSC VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 LITTLEBURY DR
CHESTER VA
23831-7108
US

IV. Provider business mailing address

3113 LITTLEBURY DR
CHESTER VA
23831-7108
US

V. Phone/Fax

Practice location:
  • Phone: 804-302-4477
  • Fax: 804-302-4474
Mailing address:
  • Phone: 804-302-4477
  • Fax: 804-302-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOY J JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-302-4477