Provider Demographics
NPI:1932466190
Name:F.C. OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:F.C. OF VIRGINIA, INC.
Other - Org Name:INTREPID USA HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:4055 VALLEY VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:DALLS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:214-445-3750
Mailing Address - Fax:
Practice Address - Street 1:322 CLOVERLEAF SQUARE
Practice Address - Street 2:PROFESSIONAL COMPLEX BUILDING E , SUITE1
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-2752
Practice Address - Country:US
Practice Address - Phone:276-523-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health