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General NPI Number Information
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NPI Number | 1093175663
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Entity Type | Organization
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Legal Business Name | FIRSTCARE FLU & WELLNESS, LLC
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 1751 PINNACLE DR SUITE 600
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City | MC LEAN
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State | VA
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Zip | 22102-4903
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Country | US
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Telephone | 800-750-2019
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Fax | 909-295-3142
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Provider Business Mailing Address
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Address Line | 1751 PINNACLE DR SUITE 600
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City | MC LEAN
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State | VA
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Zip | 22102-4903
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Country | US
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Telephone | 800-750-2019
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Fax | 909-295-3142
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Authorized Official
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Title or Position | CEO
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Name | MR. WILTON RICARDO SCOTT
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Credential |
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Telephone | 909-784-2203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 0102201555
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0102201555
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 0102201555
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0102201555
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0102201555
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0102201555
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0102201555
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License Number State | VA
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