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General NPI Number Information
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NPI Number | 1790115244
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Entity Type | Organization
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Legal Business Name | NILECRAM REHAB GROUP LLC
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 4222 FORTUNA CENTER PLZ #108
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City | DUMFRIES
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State | VA
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Zip | 22025-1515
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Country | US
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Telephone | 866-644-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 4222 FORTUNA CENTER PLAZA #108
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City | DUMFRIES
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State | VA
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Zip | 22025
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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 | DIRECTOR OF NURSING
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Name | LORNA BENOIT
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Credential | RRT
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Telephone | 718-810-2317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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