Provider Demographics
NPI:1396506473
Name:SWEET VIRGINIA CARE WV, LLC
Entity type:Organization
Organization Name:SWEET VIRGINIA CARE WV, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-496-4616
Mailing Address - Street 1:21035 SYCOLIN RD STE 55
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4311
Mailing Address - Country:US
Mailing Address - Phone:703-469-4616
Mailing Address - Fax:703-469-4615
Practice Address - Street 1:12 LOTUS AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1552
Practice Address - Country:US
Practice Address - Phone:866-520-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health