Provider Demographics
NPI:1467901736
Name:OVAL BEACH, LLC
Entity Type:Organization
Organization Name:OVAL BEACH, LLC
Other - Org Name:COMFORT KEEPERS MANASSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-628-2629
Mailing Address - Street 1:9720 CAPITAL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2049
Mailing Address - Country:US
Mailing Address - Phone:703-686-4820
Mailing Address - Fax:703-686-4854
Practice Address - Street 1:9720 CAPITAL CT STE 100
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2049
Practice Address - Country:US
Practice Address - Phone:703-686-4820
Practice Address - Fax:703-686-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171284251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health