Provider Demographics
NPI:1700031077
Name:'C' CASTING CARE
Entity Type:Organization
Organization Name:'C' CASTING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE DUTY
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:804-274-0640
Mailing Address - Street 1:5107 BLOSSOMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7023
Mailing Address - Country:US
Mailing Address - Phone:804-763-4141
Mailing Address - Fax:
Practice Address - Street 1:5107 BLOSSOMWOOD CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7023
Practice Address - Country:US
Practice Address - Phone:804-763-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-29
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401054180251B00000X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0157059574Medicaid