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General NPI Number Information
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NPI Number | 1265282362
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Entity Type | Organization
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Legal Business Name | MEDACI WELLNESS INSTITUTE LP
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 14 MEDICAL CENTER DR
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City | SUPPLY
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State | NC
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Zip | 28462-3350
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Country | US
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Telephone | 703-623-3719
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W MARSHALL ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4012
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Country | US
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Telephone | 703-623-3719
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TODD HUGHES
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Credential | CRNA
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Telephone | 703-623-3719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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