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General NPI Number Information
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NPI Number | 1538930037
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Entity Type | Organization
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Legal Business Name | CARE IMPACT 4, LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 5100 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5069
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Country | US
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Telephone | 703-845-5013
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Fax | 703-845-2976
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Provider Business Mailing Address
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Address Line | 5100 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5069
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Country | US
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Telephone | 703-845-5013
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER ANNE RAUSCHENBERG
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Credential | OTR/L
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Telephone | 804-677-0415
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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 |
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License Number State |
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