Provider Demographics
NPI:1194152454
Name:PRIMARY CHOICE HEALTH CARE,LLC
Entity type:Organization
Organization Name:PRIMARY CHOICE HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RESURRECION
Authorized Official - Middle Name:B
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-992-8708
Mailing Address - Street 1:140 LITTLE FALLS ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4323
Mailing Address - Country:US
Mailing Address - Phone:703-992-8708
Mailing Address - Fax:
Practice Address - Street 1:140 LITTLE FALLS ST., SUITE 205
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-992-8708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO141007251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO141007OtherCOMMONWEALTH OF VIRGINIA. VIRGINIA DEPARTMENT OF HEALTH
VA1209275468OtherSTATE CORPORATION COMMISSION