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General NPI Number Information
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NPI Number | 1992269872
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Entity Type | Organization
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Legal Business Name | QUEENS UNITED WELLNESS CENTER,LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 676 OLEANDER CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4218
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Country | US
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Telephone | 757-389-3005
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Fax | 757-495-0729
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Provider Business Mailing Address
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Address Line | 676 OLEANDER CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4218
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Country | US
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Telephone | 757-389-3005
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Fax | 757-495-0729
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MRS. QUEEN R FITZGERALD
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Credential |
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Telephone | 757-389-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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