Provider Demographics
NPI:1578721361
Name:ACCREDITED HEALTHCARE CORP
Entity Type:Organization
Organization Name:ACCREDITED HEALTHCARE CORP
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:ETUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-201-3502
Mailing Address - Street 1:4602 WEST GROVE COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5414
Mailing Address - Country:US
Mailing Address - Phone:757-201-3502
Mailing Address - Fax:757-671-3345
Practice Address - Street 1:4602 WESTGROVE CT
Practice Address - Street 2:SUITE B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5414
Practice Address - Country:US
Practice Address - Phone:757-201-3502
Practice Address - Fax:757-671-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization