Healthcare Provider Details

I. General information

NPI: 1053516344
Provider Name (Legal Business Name): FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10514 WAKEMAN DR
FREDERICKSBURG VA
22407-8040
US

IV. Provider business mailing address

4343 PLANK RD STE 100
FREDERICKSBURG VA
22407-4807
US

V. Phone/Fax

Practice location:
  • Phone: 540-907-4555
  • Fax: 540-371-8446
Mailing address:
  • Phone: 540-907-4555
  • Fax: 540-371-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LYTTLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-907-4555