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General NPI Number Information
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NPI Number | 1811358187
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Entity Type | Organization
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Legal Business Name | IMPERIAL CARE, LLC
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 7001 LOISDALE RD SUITE C-2ND FLOOR
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1904
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Country | US
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Telephone | 240-604-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 6564 LOISDALE CT SUITE 600-D
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1827
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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 | CEO
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Name | MR. CLAUDE J HENDJE
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Credential |
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Telephone | 240-604-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2231
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2231
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License Number State | VA
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