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General NPI Number Information
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NPI Number | 1952758567
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Entity Type | Organization
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Legal Business Name | BELOVED1 LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 15471 PAPILLON PL
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3399
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Country | US
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Telephone | 703-334-6621
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Fax | 703-334-6615
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Provider Business Mailing Address
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Address Line | 15471 PAPILLON PL
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3399
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Country | US
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Telephone | 703-334-6621
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Fax | 703-334-6615
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Authorized Official
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Title or Position | OWNER
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Name | DR. EBERECHI CORNELIA EKECHUKWU
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Credential |
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Telephone | 703-334-6621
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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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