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General NPI Number Information
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NPI Number | 1477183382
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE CARE OF VIRGINIA AT FREDERICKSBURG, LLC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 1320 CENTRAL PARK BLVD STE 200
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4953
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Country | US
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Telephone | 917-733-1135
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Fax |
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Provider Business Mailing Address
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Address Line | 517 W SADDLE RIVER RD
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City | UPPER SADDLE RIVER
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State | NJ
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Zip | 07458-1138
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Country | US
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Telephone | 917-733-1135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLISON VIAR
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Credential |
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Telephone | 917-733-1135
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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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