Healthcare Provider Details

I. General information

NPI: 1588156277
Provider Name (Legal Business Name): CAMPBELL'S QUALITY CARE, CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 WILSON FARM RD
KEYSVILLE VA
23947-2811
US

IV. Provider business mailing address

PO BOX 66
FARMVILLE VA
23901-0066
US

V. Phone/Fax

Practice location:
  • Phone: 434-298-7433
  • Fax: 434-696-1355
Mailing address:
  • Phone: 434-298-7433
  • Fax: 434-696-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. MICHELLE RENEE' RUNION
Title or Position: PRESIDENT
Credential: HUMAN SERVICES DEGRE
Phone: 434-298-7433