Provider Demographics
NPI:1942527874
Name:GREATER PRINCE WILLIAM AREA COMMUNITY HEATLH CENTER
Entity Type:Organization
Organization Name:GREATER PRINCE WILLIAM AREA COMMUNITY HEATLH CENTER
Other - Org Name:GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCIPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-680-7950
Mailing Address - Street 1:PO BOX 6966
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0966
Mailing Address - Country:US
Mailing Address - Phone:804-237-7690
Mailing Address - Fax:804-237-7697
Practice Address - Street 1:4379 RIDGEWOOD CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8322
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)