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General NPI Number Information
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NPI Number | 1740651546
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Entity Type | Organization
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Legal Business Name | WHEELER SUPPORTIVE SERVICES, INC.
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 800 CORPORATE DR SUITE 301
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City | STAFFORD
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State | VA
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Zip | 22554-4889
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Country | US
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Telephone | 415-240-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1042
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City | DUMFRIES
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State | VA
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Zip | 22026-9042
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Country | US
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Telephone | 415-240-3100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ZACKERY WHEELER
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Credential | SW
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Telephone | 415-240-3100
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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 | 2274
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License Number State | VA
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