Organization
SENIOR AND ADULT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WETHAK TAWFIQ ANSARI (BUSINESS ADMINISTRATOR)
(540) 785-9900
Entity
Organization
Contact information
Practice address
11400 BURNSIDE PL, SPOTSYLVANIA, VA 22553-4617
(540) 785-9900
(540) 785-9960
Mailing address
11400 BURNSIDE PL, SPOTSYLVANIA, VA 22551-4617
(540) 785-9900
(540) 785-9960
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005879761
VA PREMIER
VA
05
—
007596117
—
VA
01
—
DC9013
RAIL ROAD MEDICARE
VA
Enumeration date
11/21/2006
Last updated
11/07/2013
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