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General NPI Number Information
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NPI Number | 1619195526
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Entity Type | Organization
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Legal Business Name | CENTER FOR WELL BEING OF BURKE INC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 5417C BACKLICK ROAD
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3915
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Country | US
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Telephone | 703-909-0299
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Fax | 703-451-9043
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Provider Business Mailing Address
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Address Line | 6657 OLD BLACKSMITH DRIVE
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City | BURKE
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State | VA
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Zip | 22015-4139
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Country | US
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Telephone | 703-909-0299
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Fax | 703-451-9043
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LORRAINE (ANN WEST) HANCOCK
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Credential | RN, CMT, CLT-LANA (R
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Telephone | 703-909-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0001068875
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License Number State | VA
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