Provider Demographics
NPI:1093175663
Name:FIRSTCARE FLU & WELLNESS, LLC
Entity Type:Organization
Organization Name:FIRSTCARE FLU & WELLNESS, LLC
Other - Org Name:FIRSTCARE GOVSOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-784-2203
Mailing Address - Street 1:1751 PINNACLE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4903
Mailing Address - Country:US
Mailing Address - Phone:800-750-2019
Mailing Address - Fax:909-295-3142
Practice Address - Street 1:1751 PINNACLE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4903
Practice Address - Country:US
Practice Address - Phone:800-750-2019
Practice Address - Fax:909-295-3142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRSTCARE WELLNESS GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201555133NN1002X, 171000000X, 172V00000X, 251E00000X, 253Z00000X, 302R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty