Provider Demographics
NPI:1851976914
Name:MEDI KIDS VA LLC
Entity Type:Organization
Organization Name:MEDI KIDS VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-400-3886
Mailing Address - Street 1:207 GRANBY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1825
Mailing Address - Country:US
Mailing Address - Phone:703-400-3886
Mailing Address - Fax:
Practice Address - Street 1:207 GRANBY ST STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1825
Practice Address - Country:US
Practice Address - Phone:703-400-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health