Provider Demographics
NPI:1851315295
Name:BENEDICTUS CARE
Entity Type:Organization
Organization Name:BENEDICTUS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:703-978-0453
Mailing Address - Street 1:5408 TRIPOLIS CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1968
Mailing Address - Country:US
Mailing Address - Phone:703-978-0453
Mailing Address - Fax:
Practice Address - Street 1:5408 TRIPOLIS CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1968
Practice Address - Country:US
Practice Address - Phone:703-978-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care