Provider Demographics
NPI:1700367679
Name:HEALTHY SCHOOLS VIRGINIA LLC
Entity Type:Organization
Organization Name:HEALTHY SCHOOLS VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-379-5997
Mailing Address - Street 1:3546 SAINT JOHNS BLUFF RD S UNIT 113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2714
Mailing Address - Country:US
Mailing Address - Phone:904-379-5997
Mailing Address - Fax:
Practice Address - Street 1:9603 GAYTON RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4964
Practice Address - Country:US
Practice Address - Phone:571-289-1765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty