Provider Demographics
NPI:1740668169
Name:FIRST HEALTHCARE REHABILITATION, LLC
Entity type:Organization
Organization Name:FIRST HEALTHCARE REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-643-5523
Mailing Address - Street 1:22570 MARKEY CT STE 220
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6915
Mailing Address - Country:US
Mailing Address - Phone:703-444-6215
Mailing Address - Fax:703-444-9145
Practice Address - Street 1:20130 LAKEVIEW CENTER PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5904
Practice Address - Country:US
Practice Address - Phone:703-840-5467
Practice Address - Fax:301-808-0360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST HEALTHCARE NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-18
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO151277320900000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740668169Medicaid
VA1922371418Medicaid