Healthcare Provider Details

I. General information

NPI: 1811358187
Provider Name (Legal Business Name): IMPERIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 LOISDALE RD SUITE C-2ND FLOOR
SPRINGFIELD VA
22150-1904
US

IV. Provider business mailing address

6564 LOISDALE CT SUITE 600-D
SPRINGFIELD VA
22150-1827
US

V. Phone/Fax

Practice location:
  • Phone: 240-604-1999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2231
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2231
License Number StateVA

VIII. Authorized Official

Name: MR. CLAUDE J HENDJE
Title or Position: CEO
Credential:
Phone: 240-604-1999