Healthcare Provider Details

I. General information

NPI: 1104171669
Provider Name (Legal Business Name): CAREONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ELLERSLIE AVE
COLONIAL HEIGHTS VA
23834-1720
US

IV. Provider business mailing address

831 EAST ELLERSLIE AVE
COLONIAL HEIGHTS VA
23834
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-8600
  • Fax:
Mailing address:
  • Phone: 804-524-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0131000628
License Number StateVA

VIII. Authorized Official

Name: DONNA WHITE FRANCIS
Title or Position: OCCUPATIONAL THERAPY ASSISTANT
Credential:
Phone: 804-520-1595