MEDICARE: LOUISE W. EGGLESTON CENTER, INC.

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	1041S0200X	School Social Worker	167	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467887612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISE W. EGGLESTON CENTER, INC.

Provider Business Mailing Address
First Line	:	51 BATTLE RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1403
Country	:	US
Telephone Number	:	757-224-9680
Fax Number	:	757-224-9715

Provider Business Practice Location Address
First Line	:	51 BATTLE RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1403
Country	:	US
Telephone Number	:	757-224-9680
Fax Number	:	757-224-9715

Authorized Official
Title or Position	:	CFO
Name	:	MR. RICKY ALLEN BIGGS
Credential	:	CPA
Telephone Number	:	757-321-6836

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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