Organization
'C' CASTING CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS VIRGINIA JACKSON CNA (PRIVATE DUTY)
(804) 274-0640
Entity
Organization
Contact information
Practice address
5107 BLOSSOMWOOD CT, CHESTERFIELD, VA 23832-7023
(804) 763-4141
Mailing address
5107 BLOSSOMWOOD CT, CHESTERFIELD, VA 23832-7023
(804) 763-4141
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
1401054180
VA
251E00000X
Home Health Agency
1401054180
VA
251J00000X
Nursing Care Agency
1401054180
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157059574
—
VA
Enumeration date
11/29/2008
Last updated
04/28/2009
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