Healthcare Provider Details

I. General information

NPI: 1750838520
Provider Name (Legal Business Name): HUGHES HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAROLINE ST
FREDERICKSBURG VA
22401-6104
US

IV. Provider business mailing address

100 CAROLINE ST
FREDERICKSBURG VA
22401-6104
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-4100
  • Fax:
Mailing address:
  • Phone: 540-373-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC566231
License Number StateVA

VIII. Authorized Official

Name: DARYL SULLIVAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 540-373-4100