Provider Demographics
NPI:1043286628
Name:AMERICAN CRITICAL CARE SERVICES, INC.
Entity Type:Organization
Organization Name:AMERICAN CRITICAL CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:WHITLEY
Authorized Official - Last Name:MCCROCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:804-320-1113
Mailing Address - Street 1:221 RUTHERS RD
Mailing Address - Street 2:P.O. BOX 35717, SUITE 103
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5395
Mailing Address - Country:US
Mailing Address - Phone:804-320-1113
Mailing Address - Fax:804-330-9460
Practice Address - Street 1:221 RUTHERS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5395
Practice Address - Country:US
Practice Address - Phone:804-320-1113
Practice Address - Fax:804-330-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1088658251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA037118OtherANTHEM BLUE CROSS