Provider Demographics
NPI:1952668709
Name:MARY GRACE RAFANAN
Entity Type:Organization
Organization Name:MARY GRACE RAFANAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY GRACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAFANAN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:757-515-1799
Mailing Address - Street 1:704 REDLEAFE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3225
Mailing Address - Country:US
Mailing Address - Phone:757-819-6918
Mailing Address - Fax:
Practice Address - Street 1:704 REDLEAFE CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3225
Practice Address - Country:US
Practice Address - Phone:757-819-6918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA031000985251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care