=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427355908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANCISCAN BRETHREN OF ST PHILIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6422 CENTERVILLE RD
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23188-1739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-208-0224
-----------------------------------------------------
Fax | 757-208-0349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1356
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23187-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-208-0224
-----------------------------------------------------
Fax | 757-208-0348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. MARGARETWALUBUKA WALUBUKA
-----------------------------------------------------
Credential | QMRP
-----------------------------------------------------
Telephone | 757-256-6937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 750-02-006
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------