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General NPI Number Information
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NPI Number | 1780059840
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Entity Type | Organization
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Legal Business Name | THE LONG ADVOCACY GROUP
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 483 MAIN STREET
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City | WARSAW
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State | VA
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Zip | 22572
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Country | US
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Telephone | 240-793-1375
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1063
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City | WARSAW
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State | VA
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Zip | 22572-1063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ERICA LONG
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Credential | CNA
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Telephone | 240-793-1375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State | VA
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