Provider Demographics
NPI:1043769664
Name:VIRGINIA LOVING SERVICES
Entity Type:Organization
Organization Name:VIRGINIA LOVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-234-7960
Mailing Address - Street 1:8343 PRINCETON SQUARE BLVD E
Mailing Address - Street 2:APT 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-234-7960
Mailing Address - Fax:
Practice Address - Street 1:8343 PRINCETON SQUARE BLVD E
Practice Address - Street 2:APT 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8389
Practice Address - Country:US
Practice Address - Phone:904-234-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty