Healthcare Provider Details

I. General information

NPI: 1578522363
Provider Name (Legal Business Name): MVLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 FULLERTON ROAD SUITE 110
SPRINGFIELD VA
22153-2836
US

IV. Provider business mailing address

7420 FULLERTON RD STE 110
SPRINGFIELD VA
22153-2836
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-3900
  • Fax: 703-569-3932
Mailing address:
  • Phone: 703-569-3900
  • Fax: 703-569-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number147-02-006
License Number StateVA

VIII. Authorized Official

Name: MRS. APRIL PINCH-KEELER
Title or Position: PRESIDENT
Credential:
Phone: 703-569-3900