Provider Demographics
NPI:1891362190
Name:AERIECARE, LLC
Entity Type:Organization
Organization Name:AERIECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:FINN
Authorized Official - Last Name:FEDORCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-610-7393
Mailing Address - Street 1:140 REHOBOTH LN NE STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-1130
Mailing Address - Country:US
Mailing Address - Phone:410-610-7393
Mailing Address - Fax:
Practice Address - Street 1:140 REHOBOTH LN NE STE 100
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-1130
Practice Address - Country:US
Practice Address - Phone:410-610-7393
Practice Address - Fax:540-745-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPRIVATE INUSRERS
VAPENDINGMedicaid