Healthcare Provider Details

I. General information

NPI: 1700031077
Provider Name (Legal Business Name): 'C' CASTING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2008
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 BLOSSOMWOOD CT
CHESTERFIELD VA
23832-7023
US

IV. Provider business mailing address

5107 BLOSSOMWOOD CT
CHESTERFIELD VA
23832-7023
US

V. Phone/Fax

Practice location:
  • Phone: 804-763-4141
  • Fax:
Mailing address:
  • Phone: 804-763-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1401054180
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1401054180
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1401054180
License Number StateVA

VIII. Authorized Official

Name: DORIS VIRGINIA JACKSON
Title or Position: PRIVATE DUTY
Credential: CNA
Phone: 804-274-0640