Provider Demographics
NPI:1578522363
Name:MVLE
Entity Type:Organization
Organization Name:MVLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCH-KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-569-3900
Mailing Address - Street 1:7420 FULLERTON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2836
Mailing Address - Country:US
Mailing Address - Phone:703-569-3900
Mailing Address - Fax:703-569-3932
Practice Address - Street 1:7420 FULLERTON ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2836
Practice Address - Country:US
Practice Address - Phone:703-569-3900
Practice Address - Fax:703-569-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA147-02-006315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945999OtherPROVIDER NUMBER