Organization
CLASSIC CAREGIVERS
Active
Other names
Classic Caregivers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA KERSHES (OWNER)
(877) 201-4579
Entity
Organization
Contact information
Practice address
6506 ROCK CRYSTAL DR, CLIFTON, VA 20124-2520
(877) 201-4579
(703) 520-2802
Mailing address
6506 ROCK CRYSTAL DR, CLIFTON, VA 20124-2520
(877) 201-4579
(703) 520-2802
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HCO151201
VA
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1355991
FAIRFAX COUNTY BUSINESS, PROFESSIONAL & OCCUPATIONAL LICENSE
VA
01
—
HCO151201
VDOH
VA
Enumeration date
03/12/2014
Last updated
09/16/2014
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