=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720376387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINSON HALL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2011
-----------------------------------------------------
Last Update Date | 07/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1728 KIRBY RD
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-4816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-970-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6251 OLD DOMINION DR
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. ROBERT CLEMENTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-538-2971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | FLO1101410L154
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------