Provider Demographics
NPI:1609141019
Name:ON THE GO MEDICAL STAFFING AND EDUCATION
Entity Type:Organization
Organization Name:ON THE GO MEDICAL STAFFING AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/NURSE INSTRUCTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-268-9366
Mailing Address - Street 1:14579 GOLDEN OAK RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2261
Mailing Address - Country:US
Mailing Address - Phone:571-268-9366
Mailing Address - Fax:
Practice Address - Street 1:555 GROVE ST STE 100
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4728
Practice Address - Country:US
Practice Address - Phone:571-707-9812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001197288251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001197288OtherVIRGINIA NURSING LICENSE NUMBER