=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851871933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLATONS PERSONAL CONCIERGES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2018
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 ROANOKE DR SE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20175-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-973-8745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 ROANOKE DR SE
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20175-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-973-8745
-----------------------------------------------------
Fax | 209-722-9088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBBIE WHEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-973-8745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------