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General NPI Number Information
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NPI Number | 1659723757
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Entity Type | Organization
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Legal Business Name | CENTRAL SENIOR CENTER, INC
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 6214 OLD KEENE MILL CT
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City | SPRINGFIELD
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State | VA
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Zip | 22152-2327
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Country | US
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Telephone | 703-517-0283
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Fax | 703-569-0600
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Provider Business Mailing Address
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Address Line | 6214 OLD KEENE MILL CT
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City | SPRINGFIELD
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State | VA
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Zip | 22152-2327
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Country | US
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Telephone | 703-517-0283
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Fax | 703-569-0600
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. HEISUNG JUHN LEE
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Credential | PHD
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Telephone | 703-517-0283
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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-161001
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License Number State | VA
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