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MVLE

Intermediate Care Mentally Retarded

Springfield, Virginia

Provider NPI: 1578522363

Organization Information:
Organization Name:  MVLE
Organization is not Subpart
Authorized Official:  APRIL  PINCH-KEELER  PRESIDENT  703-5693900

Practice Location:
7420 FULLERTON ROAD SUITE 110 SPRINGFIELD, VA 22153 US
Tel: 703-569-3900  Fax: 703-569-3932

Business Mailing Address:
7420 FULLERTON RD STE 110  SPRINGFIELD, VA 22153 US
Tel: 703-569-3900  Fax: 703-569-3932

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
VA147-02-006

Other Provider Identifiers:

IssuerNumberStateType
PROVIDER NUMBER004945999VA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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