Provider Demographics
NPI:1619152832
Name:CHARCO AGENCY
Entity Type:Organization
Organization Name:CHARCO AGENCY
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE / DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDIAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-369-2503
Mailing Address - Street 1:10013 MOXLEYS FORD LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-3004
Mailing Address - Country:US
Mailing Address - Phone:703-369-2503
Mailing Address - Fax:703-369-2503
Practice Address - Street 1:10013 MOXLEYS FORD LN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-3004
Practice Address - Country:US
Practice Address - Phone:703-369-2503
Practice Address - Fax:703-369-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health