Healthcare Provider Details

I. General information

NPI: 1508311838
Provider Name (Legal Business Name): WELL BEING ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 OLD LEE HWY SUITE 210
FAIRFAX VA
22031-4315
US

IV. Provider business mailing address

2812 OLD LEE HWY SUITE 210
FAIRFAX VA
22031-4315
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-2828
  • Fax:
Mailing address:
  • Phone: 703-204-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1103743-L152
License Number StateVA

VIII. Authorized Official

Name: JEANNIE CHANG
Title or Position: ADMINISTRATION
Credential:
Phone: 703-204-2820