Organization
MYPOTENTIAL VIRGINIA, LLC
Active
Parent organization
NATIONAL LUTERAN HOME FOR THE AGED, INC.
Other names
myPotential at Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
NATIONAL LUTERAN HOME FOR THE AGED, INC.
Authorized official
MR. MICHAEL JOSEPH BRADY SR. CPA (CHIEF FINANCIAL OFFICER)
(301) 354-2714
Entity
Organization
Contact information
Practice address
320 WESTSIDE STATION DR, WINCHESTER, VA 22601-2839
(540) 450-0343
(540) 723-0858
Mailing address
2301 RESEARCH BLVD, SUITE 310, ROCKVILLE, MD 20850-3204
(301) 354-2710
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HCO-151094
VA
Other
Enumeration date
06/10/2015
Last updated
06/10/2015
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