Provider Demographics
NPI:1023396892
Name:FREDERICKSBURG AREA REGIONAL HEALTH COUNCIL
Entity Type:Organization
Organization Name:FREDERICKSBURG AREA REGIONAL HEALTH COUNCIL
Other - Org Name:LLOYD F. MOSS FREE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DULANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1065
Mailing Address - Street 1:1301 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8420
Mailing Address - Country:US
Mailing Address - Phone:540-741-1065
Mailing Address - Fax:540-741-1096
Practice Address - Street 1:1301 SAM PERRY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8420
Practice Address - Country:US
Practice Address - Phone:540-741-1055
Practice Address - Fax:540-741-3103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICKSBURG AREA REGIONAL HEALTH COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-28
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003169261Q00000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center