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General NPI Number Information
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NPI Number | 1235511163
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Entity Type | Organization
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Legal Business Name | CLINICA IMPERIAL, LLC
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 6413 HACKNEY CIR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-4573
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Country | US
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Telephone | 804-833-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 9453 AMBERDALE DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1249
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Country | US
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Telephone | 804-447-9540
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM SIMON
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Credential |
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Telephone | 804-833-2900
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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