Organization
CORNER PIECE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN W SMITH (DIRECTOR OF OPERATIONS)
(571) 383-6914
Entity
Organization
Contact information
Practice address
9420 WORTHINGTON DR, BRISTOW, VA 20136-5756
(571) 336-2221
(571) 522-2705
Mailing address
9420 WORTHINGTON DR, BRISTOW, VA 20136-5756
(571) 336-2221
(571) 522-2705
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
0133000112
VA
251C00000X
Developmentally Disabled Services Day Training Agency
0134000045
VA
251S00000X
Community/Behavioral Health Agency
0133000112
VA
251S00000X
Community/Behavioral Health Agency
0134000045
VA
252Y00000X
Early Intervention Provider Agency
Primary
0133000112
VA
252Y00000X
Early Intervention Provider Agency
0134000045
VA
253Z00000X
In Home Supportive Care Agency
0133000112
VA
253Z00000X
In Home Supportive Care Agency
0134000045
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0133000112
BCBA
VA
01
—
0133000480
VIRGINIA BOARD OF MEDICINE
VA
01
—
0134000045
BCABA
VA
Enumeration date
06/27/2014
Last updated
09/01/2014
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