=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043286628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN CRITICAL CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 RUTHERS RD SUITE 103
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-320-1113
-----------------------------------------------------
Fax | 804-330-9460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 RUTHERS RD P.O. BOX 35717, SUITE 103
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-5395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-320-1113
-----------------------------------------------------
Fax | 804-330-9460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CAROLYN WHITLEY MCCROCKLIN
-----------------------------------------------------
Credential | RN,BSN
-----------------------------------------------------
Telephone | 804-320-1113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1088658
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------