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General NPI Number Information
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NPI Number | 1780950022
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Entity Type | Organization
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Legal Business Name | UNIVERSAL COMPANION CARE SERVICES
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 106 WELLINGTON LAKES DR. APT. 31
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-9524
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Country | US
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Telephone | 540-479-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 106 WELLINGTON LAKES DR APT 31
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-2132
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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 | OWNER
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Name | MS. JEWEL LUMAURE WIGGLESWORTH
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Credential |
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Telephone | 540-479-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 45-492672
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License Number State | VA
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