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NPI Code Detail

MEDICARE: PROVIDENCE REALTY & FINANCIAL MUTUAL

MEDICARE: PROVIDENCE REALTY & FINANCIAL MUTUAL
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
1253Z00000XIn Home Supportive Care AgencyVA

General Provider Information

NPI Number : 1447753447
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE REALTY & FINANCIAL MUTUAL
Provider Business Mailing Address
First Line : 2702 PERDUE CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2149
Country : US
Telephone Number : 804-318-7978
Fax Number :
Provider Business Practice Location Address
First Line : 2702 PERDUE CT
Second Line :
City : CHESTER
State : VA
Zip : 23831-2149
Country : US
Telephone Number : 804-318-7978
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. CHRISTOPHER RUSS
Credential :
Telephone Number : 804-318-7978
Provider Enumeration Date : 03/15/2018
Last Update Date : 03/15/2018

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Directions to “PROVIDENCE REALTY & FINANCIAL MUTUAL ” Practice Location

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