Healthcare Provider Details

I. General information

NPI: 1235632720
Provider Name (Legal Business Name): FAMILY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 BACKLICK RD STE 210
SPRINGFIELD VA
22150-2806
US

IV. Provider business mailing address

6560 BACKLICK RD STE 210
SPRINGFIELD VA
22150-2806
US

V. Phone/Fax

Practice location:
  • Phone: 571-216-2771
  • Fax:
Mailing address:
  • Phone: 571-216-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateVA

VIII. Authorized Official

Name: LIBAN FARAH
Title or Position: MANAGER
Credential:
Phone: 571-422-0988