Provider Demographics
NPI:1619195526
Name:CENTER FOR WELL BEING OF BURKE INC
Entity Type:Organization
Organization Name:CENTER FOR WELL BEING OF BURKE INC
Other - Org Name:LYMPHEDEMA HELP CENTER, SPRINGFIELD MASSAGE CENTER FOR WOMEN, BURKE MA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:(ANN WEST)
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CMT, CLT-LANA (R
Authorized Official - Phone:703-909-0299
Mailing Address - Street 1:6657 OLD BLACKSMITH DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4139
Mailing Address - Country:US
Mailing Address - Phone:703-909-0299
Mailing Address - Fax:703-451-9043
Practice Address - Street 1:5417C BACKLICK ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-909-0299
Practice Address - Fax:703-451-9043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR WELL- BEING OF BURKE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001068875261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty