Provider Demographics
NPI:1275790412
Name:NORTHERN NECK FREE HEALTH CLINIC
Entity Type:Organization
Organization Name:NORTHERN NECK FREE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-435-0575
Mailing Address - Street 1:51 WILLIAM B GRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3852
Mailing Address - Country:US
Mailing Address - Phone:804-435-0575
Mailing Address - Fax:
Practice Address - Street 1:51 WILLIAM B GRAHAM CT
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3852
Practice Address - Country:US
Practice Address - Phone:804-435-0575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health