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General NPI Number Information
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NPI Number | 1831574078
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Entity Type | Organization
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Legal Business Name | TWENTY PACK MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 5900 WILSON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22205-1548
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Country | US
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Telephone | 703-536-1060
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Fax | 703-444-8294
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Provider Business Mailing Address
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Address Line | 5900 WILSON BLVD
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City | ARLINGTON
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State | VA
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Zip | 22205-1548
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Country | US
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Telephone | 703-536-1060
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Fax | 703-444-8294
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RAYMOND DENNISON
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Credential |
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Telephone | 703-536-1060
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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 | BLC-1000030930-05
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License Number State | VA
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