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General NPI Number Information
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NPI Number | 1265753875
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Entity Type | Organization
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Legal Business Name | LIFTING AS WE CLIMB COMMUNITY SERVICES, LLC
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 3058 PS BUSINESS CENTER DRIVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 571-408-4291
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Fax |
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Provider Business Mailing Address
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Address Line | 3058 PS BUSINESS CENTER DRIVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 571-408-4291
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY JAMES
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Credential |
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Telephone | 202-498-4408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1328-003
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License Number State | VA
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