Provider Demographics
NPI:1730127374
Name:SUREFIRE HEALTH CARE PROFESSIONALS
Entity Type:Organization
Organization Name:SUREFIRE HEALTH CARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:VIEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CNA
Authorized Official - Phone:540-361-7461
Mailing Address - Street 1:3330 BOURBON ST
Mailing Address - Street 2:123
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-361-7461
Mailing Address - Fax:540-361-7462
Practice Address - Street 1:6519 MACEDONIA RD
Practice Address - Street 2:
Practice Address - City:WOODFORD
Practice Address - State:VA
Practice Address - Zip Code:22580-3311
Practice Address - Country:US
Practice Address - Phone:804-633-6563
Practice Address - Fax:804-633-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7016853305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization