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General NPI Number Information
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NPI Number | 1043769664
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Entity Type | Organization
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Legal Business Name | VIRGINIA LOVING SERVICES
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 8343 PRINCETON SQUARE BLVD E APT 105
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8389
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Country | US
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Telephone | 904-234-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 8343 PRINCETON SQUARE BLVD E APT 105
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 904-234-7960
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. SHANNON NICOLE WILSON
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Credential |
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Telephone | 904-234-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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