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General NPI Number Information
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NPI Number | 1417373622
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Entity Type | Organization
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Legal Business Name | CLASSIC CAREGIVERS
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 6506 ROCK CRYSTAL DR
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City | CLIFTON
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State | VA
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Zip | 20124-2520
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Country | US
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Telephone | 877-201-4579
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Fax | 703-520-2802
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Provider Business Mailing Address
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Address Line | 6506 ROCK CRYSTAL DR
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City | CLIFTON
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State | VA
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Zip | 20124-2520
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Country | US
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Telephone | 877-201-4579
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Fax | 703-520-2802
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA KERSHES
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Credential |
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Telephone | 877-201-4579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO151201
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License Number State | VA
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