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General NPI Number Information
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NPI Number | 1194152454
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Entity Type | Organization
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Legal Business Name | PRIMARY CHOICE HEALTH CARE,LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 140 LITTLE FALLS ST., SUITE 205
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City | FALLS CHURCH
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State | VA
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Zip | 22046
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Country | US
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Telephone | 703-992-8708
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Fax |
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Provider Business Mailing Address
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Address Line | 140 LITTLE FALLS ST STE 205
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4323
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Country | US
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Telephone | 703-992-8708
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RESURRECION B VILLAR
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Credential |
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Telephone | 703-992-8708
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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 | HCO141007
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License Number State | VA
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