Provider Demographics
NPI:1790950681
Name:DISABILITY RESOURCE CENTER OF THE RAPPAHANNOCK
Entity Type:Organization
Organization Name:DISABILITY RESOURCE CENTER OF THE RAPPAHANNOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:FULTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-373-2559
Mailing Address - Street 1:409 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3337
Mailing Address - Country:US
Mailing Address - Phone:540-373-2559
Mailing Address - Fax:
Practice Address - Street 1:409 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3337
Practice Address - Country:US
Practice Address - Phone:540-373-2559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087430457Medicaid