Provider Demographics
NPI:1457645160
Name:SALVATION ACADEMY
Entity Type:Organization
Organization Name:SALVATION ACADEMY
Other - Org Name:SALVATION ACADEMY MEDICAL STAFFING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIMA
Authorized Official - Middle Name:BOB
Authorized Official - Last Name:DEEN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, ADBS, IMIS
Authorized Official - Phone:703-763-1115
Mailing Address - Street 1:4613 PINECREST OFFICE PARK DR
Mailing Address - Street 2:UNIT F-G
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1442
Mailing Address - Country:US
Mailing Address - Phone:703-763-1115
Mailing Address - Fax:703-226-3328
Practice Address - Street 1:4613 PINECREST OFFICE PARK DR
Practice Address - Street 2:UNIT F-G
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1442
Practice Address - Country:US
Practice Address - Phone:703-763-1115
Practice Address - Fax:706-226-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health