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General NPI Number Information
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NPI Number | 1669702726
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC FAMILY SERVICES
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 25 BETZ LN
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City | HAMPTON
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State | VA
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Zip | 23666-1405
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Country | US
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Telephone | 757-766-6007
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Fax | 757-766-6007
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Provider Business Mailing Address
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Address Line | 25 BETZ LANE
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City | HAMPTON
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State | VA
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Zip | 23666-1405
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Country | US
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Telephone | 757-766-6007
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Fax | 757-766-6007
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Authorized Official
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Title or Position | ADMINISTRATOR'S
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Name | MR. EUGENE CORNELL BOYD
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Credential |
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Telephone | 757-766-6007
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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 | 115521
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License Number State | VA
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