Provider Demographics
NPI:1871183590
Name:GUILLORY HEALTH VIRGINIA, LLC
Entity Type:Organization
Organization Name:GUILLORY HEALTH VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-373-2843
Mailing Address - Street 1:3033 WILSON BLVD STE 764
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3866
Mailing Address - Country:US
Mailing Address - Phone:703-888-5470
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD STE 764
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3866
Practice Address - Country:US
Practice Address - Phone:703-888-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management