# PEDIALAC NURSING SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PEDIALAC NURSING SERVICES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417303603
- **Authorized official:** ELIZABETH AMA CLARKE RN (ADMINSTRATOR)
- **Authorized official phone:** (540) 737-4010

## Contact information

- **Practice address:** 1127 INTERNATIONAL PKWY STE 220, FREDERICKSBRG, VA 22406-1142
- **Practice address phone:** (540) 737-4010
- **Practice address fax:** (540) 737-4011
- **Mailing address:** 1127 INTERNATIONAL PKWY STE 220, FREDERICKSBRG, VA 22406-1142
- **Mailing address phone:** (540) 737-4010
- **Mailing address fax:** (540) 737-4011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | HCO 161444 | VA | Yes |
| 251E00000X | Home Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 05/06/2016
- **Last updated:** 10/19/2021