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General NPI Number Information
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NPI Number | 1023342870
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Entity Type | Organization
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Legal Business Name | M & T UNIVERSAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 6315 BACKLICK RD STE 308
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City | SPRINGFIELD
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State | VA
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Zip | 22150
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Country | US
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Telephone | 571-830-6812
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Fax | 571-830-6813
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Provider Business Mailing Address
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Address Line | 6315 BACKLICK RD STE 308
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2608
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Country | US
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Telephone | 571-830-6812
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Fax | 571-830-6813
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIMOTHY AYONG
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Credential | B.S.C, LPN
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Telephone | 571-830-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-10596
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License Number State | VA
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