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General NPI Number Information
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NPI Number | 1952668709
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Entity Type | Organization
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Legal Business Name | MARY GRACE RAFANAN
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 704 REDLEAFE CIR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3225
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Country | US
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Telephone | 757-819-6918
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Fax |
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Provider Business Mailing Address
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Address Line | 704 REDLEAFE CIR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3225
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Country | US
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Telephone | 757-819-6918
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Fax |
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Authorized Official
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Title or Position | COTA/L
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Name | MS. MARY GRACE R RAFANAN
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Credential | COTA/L
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Telephone | 757-515-1799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 031000985
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License Number State | VA
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