Organization
WORSHIP AND PRAISES PENTECOSTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD BRISCO BS RRT CRTT NA (DIRECTOR)
(804) 687-1054
Entity
Organization
Contact information
Practice address
4011 NEWBYS BRIDGE RD, CHESTERFIELD, VA 23832-7722
(804) 687-1054
(804) 454-3080
Mailing address
4011 NEWBYS BRIDGE RD, CHESTERFIELD, VA 23832-7722
(804) 687-1054
(804) 454-3080
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0117004528
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0117004528
BOARD OF MEDICINE
VA
Enumeration date
11/11/2010
Last updated
11/11/2010
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