=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427458314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIR VENTURE ASSETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2014
-----------------------------------------------------
Last Update Date | 08/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7217 LOCKPORT PL SUITE 100
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-982-7646
-----------------------------------------------------
Fax | 703-982-7650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7217 LOCKPORT PL SUITE 100
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-982-7646
-----------------------------------------------------
Fax | 703-982-7650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | MS. IRIS RENELL HUNTER
-----------------------------------------------------
Credential | PH.D, M.ED
-----------------------------------------------------
Telephone | 703-982-7646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HCO151189
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------