Provider Demographics
NPI:1578770392
Name:VISITING NURSE SERVICE OF FREDERICKSBURG,INC..
Entity Type:Organization
Organization Name:VISITING NURSE SERVICE OF FREDERICKSBURG,INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:540-548-0590
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-0098
Mailing Address - Country:US
Mailing Address - Phone:540-548-0590
Mailing Address - Fax:540-548-0593
Practice Address - Street 1:3920 PLANK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7104
Practice Address - Country:US
Practice Address - Phone:540-548-0590
Practice Address - Fax:540-548-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO 09424OtherVIRGINIA DEPARTMENT OF HEALTH
VA9438078OtherAETNA HEALTH, INC.
VA1578770392Medicaid
VAHCO 09424OtherVIRGINIA DEPARTMENT OF HEALTH