Healthcare Provider Details

I. General information

NPI: 1235701517
Provider Name (Legal Business Name): COMPLETE CARE FOR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13204 HULL STREET RD
MIDLOTHIAN VA
23112-2620
US

IV. Provider business mailing address

13204 HULL STREET RD
MIDLOTHIAN VA
23112-2620
US

V. Phone/Fax

Practice location:
  • Phone: 804-223-5437
  • Fax: 804-999-0369
Mailing address:
  • Phone: 804-223-5437
  • Fax: 804-999-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1659385987
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 2
Identifier1932318912
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer

VIII. Authorized Official

Name: DR. SYLVIA ROZANSKI LEE
Title or Position: OWNER
Credential: MD
Phone: 804-223-5437