MEDICARE: LA SOLUCION FAMILIAR SERVICIOS PARA ADULTOS Y NINOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1763	VA

General Provider Information

NPI Number	:	1114366978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA SOLUCION FAMILIAR SERVICIOS PARA ADULTOS Y NINOS

Provider Business Mailing Address
First Line	:	221 RUTHERS RD STE 204
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-447-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 RUTHERS RD STE 204
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5395
Country	:	US
Telephone Number	:	804-447-0421
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CARLOS M GARCIA-SAMUELS
Credential	:	QMHP
Telephone Number	:	804-551-3470

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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