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General NPI Number Information
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NPI Number | 1932730140
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Entity Type | Organization
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Legal Business Name | ALTA BEACON, LLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 7910 ANDRUS RD STE 6
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3171
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Country | US
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Telephone | 571-457-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 7910 ANDRUS RD STE 6
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3171
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Country | US
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Telephone | 571-457-4894
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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. BELLA DESAI
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Credential | MPH
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Telephone | 571-457-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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