Healthcare Provider Details

I. General information

NPI: 1023396892
Provider Name (Legal Business Name): FREDERICKSBURG AREA REGIONAL HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SAM PERRY BLVD SUITE 100
FREDERICKSBURG VA
22401-8420
US

IV. Provider business mailing address

1301 SAM PERRY BLVD SUITE 100
FREDERICKSBURG VA
22401-8420
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1055
  • Fax: 540-741-3103
Mailing address:
  • Phone: 540-741-1065
  • Fax: 540-741-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0201003169
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAREN DULANEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-741-1065