Healthcare Provider Details

I. General information

NPI: 1568875235
Provider Name (Legal Business Name): C3 NEXUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N 5TH ST SUITE 500
RICHMOND VA
23219-1441
US

IV. Provider business mailing address

737 N 5TH ST SUITE 500
RICHMOND VA
23219-1441
US

V. Phone/Fax

Practice location:
  • Phone: 804-325-1122
  • Fax:
Mailing address:
  • Phone: 804-325-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number0101045588
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number0101045588
License Number StateVA

VIII. Authorized Official

Name: TONYA MALLORY
Title or Position: PRESIDENT
Credential:
Phone: 804-325-1122