Provider Demographics
NPI:1578913455
Name:CALATHEA, LLC
Entity Type:Organization
Organization Name:CALATHEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTHETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-993-3266
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:THORNBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22565-0073
Mailing Address - Country:US
Mailing Address - Phone:540-993-3266
Mailing Address - Fax:540-834-0475
Practice Address - Street 1:8613 BRIGHTON CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7721
Practice Address - Country:US
Practice Address - Phone:540-993-3266
Practice Address - Fax:540-834-0475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALATHEA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578913455Medicaid