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General NPI Number Information
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NPI Number | 1477704823
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL STAFFING LLC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 12608 LAKE RIDGE DR STE A
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2389
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Country | US
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Telephone | 703-499-9099
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Fax | 703-499-9077
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Provider Business Mailing Address
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Address Line | 12608 LAKE RIDGE DR STE A
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2389
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Country | US
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Telephone | 703-499-9099
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Fax | 703-499-9077
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN SERGENTON
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Credential |
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Telephone | 703-371-1344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-09518
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License Number State | VA
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