Basic Information
| Provider Information | |||||||||
| NPI: | 1710544283 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEIGHBORHOOD HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEIGHBORHOOD HEALTH AT SOUTH COUNTY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4320 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230584320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037780639 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8350 RICHMOND HWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223092344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355538 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | RAINEY | ||||||||
| AuthorizedOfficialFirstName: | REMONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7037780639 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.