Healthcare Provider Details

I. General information

NPI: 1750547444
Provider Name (Legal Business Name): PRINCE WILLIAM AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COUNTY COMPLEX CT SUITE 240
WOODBRIDGE VA
22192-9200
US

IV. Provider business mailing address

5 COUNTY COMPLEX CT SUITE 240
WOODBRIDGE VA
22192-9200
US

V. Phone/Fax

Practice location:
  • Phone: 703-792-6439
  • Fax: 703-792-4734
Mailing address:
  • Phone: 703-792-6439
  • Fax: 703-792-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0087303001
License Number StateVA

VIII. Authorized Official

Name: SARAH HENRY
Title or Position: DIRECTOR
Credential:
Phone: 703-792-6439