Healthcare Provider Details

I. General information

NPI: 1326459132
Provider Name (Legal Business Name): JOHN ROBERT CONSTRUCTION & REPAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11474 PINHOOK RD
ROCKVILLE VA
23146-1507
US

IV. Provider business mailing address

11474 PINHOOK RD
ROCKVILLE VA
23146-1507
US

V. Phone/Fax

Practice location:
  • Phone: 804-337-9475
  • Fax:
Mailing address:
  • Phone: 804-337-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN ROBERT RHODEBACK
Title or Position: OWNER
Credential:
Phone: 804-337-9475