MEDICARE: MVLE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	147-02-006	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004945999	OTHER	VA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1578522363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVLE

Provider Business Mailing Address
First Line	:	7420 FULLERTON RD STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2836
Country	:	US
Telephone Number	:	703-569-3900
Fax Number	:	703-569-3932

Provider Business Practice Location Address
First Line	:	7420 FULLERTON ROAD
Second Line	:	SUITE 110
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2836
Country	:	US
Telephone Number	:	703-569-3900
Fax Number	:	703-569-3932

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. APRIL PINCH-KEELER
Credential	:
Telephone Number	:	703-569-3900

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	02/18/2009

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Directions to “MVLE ” Practice Location

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