Healthcare Provider Details

I. General information

NPI: 1699199620
Provider Name (Legal Business Name): CONTINUUM PEDIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 OLD MEADOW RD SUITE 600
MC LEAN VA
22102-4311
US

IV. Provider business mailing address

1651 OLD MEADOW RD SUITE 600
MC LEAN VA
22102-4311
US

V. Phone/Fax

Practice location:
  • Phone: 703-506-0123
  • Fax: 703-734-1932
Mailing address:
  • Phone: 703-506-0123
  • Fax: 703-734-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH GREEN
Title or Position: PRESIDENT
Credential:
Phone: 703-506-0123