Provider Demographics
NPI:1184002263
Name:SANCTUS
Entity type:Organization
Organization Name:SANCTUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:SYVRET
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:703-966-5526
Mailing Address - Street 1:1372 OLD BRIDGE RD # 102
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2708
Mailing Address - Country:US
Mailing Address - Phone:703-966-5526
Mailing Address - Fax:703-680-9322
Practice Address - Street 1:1372 OLD BRIDGE RD # 102
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2708
Practice Address - Country:US
Practice Address - Phone:703-966-5526
Practice Address - Fax:703-680-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019002389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty