1750390654 NPI number — PIEDMONT HOME CARE

Table of content: (NPI 1750390654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750390654 NPI number — PIEDMONT HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750390654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22604-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5229
Provider Business Mailing Address Fax Number:
540-536-2396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 WEST LEE HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-349-1279
Provider Business Practice Location Address Fax Number:
540-349-1286
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEISEY
Authorized Official First Name:
M
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
TRESURER
Authorized Official Telephone Number:
540-536-5260

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01319498 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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