Healthcare Provider Details

I. General information

NPI: 1215352547
Provider Name (Legal Business Name): PAMCO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7316 RESPITE COURT
GAINESVILLE VA
20155
US

IV. Provider business mailing address

8905 YORKSHIRE LANE
MANASSAS VA
20111
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-7000
  • Fax: 703-257-7002
Mailing address:
  • Phone: 703-257-7000
  • Fax: 703-257-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2214
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number242225
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2214
License Number StateVA

VIII. Authorized Official

Name: PAMELA' B. LUCAS
Title or Position: OWNER
Credential:
Phone: 703-257-7000