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General NPI Number Information
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NPI Number | 1770857500
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Entity Type | Organization
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Legal Business Name | MORNINGSIDE HOUSE OF LEESBURG
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 316 HARRISON ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3719
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Country | US
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Telephone | 703-777-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 316 HARRISON ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3719
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Country | US
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Telephone | 703-777-2777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | KELLY MASON
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Credential |
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Telephone | 703-669-1804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FLO-1097320-L155
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License Number State | VA
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