MEDICARE: MULTICULTURAL CLINICAL CENTER

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	1952360612	VA

General Provider Information

NPI Number	:	1487989471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTICULTURAL CLINICAL CENTER

Provider Business Mailing Address
First Line	:	6563 EDSALL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-4414
Country	:	US
Telephone Number	:	703-354-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6563 EDSALL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-4414
Country	:	US
Telephone Number	:	703-354-0000
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. REBECCA KEEGAN
Credential	:
Telephone Number	:	703-354-0000

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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