Provider Demographics
NPI:1194452847
Name:DMV FAMILY CARE SERVICES
Entity type:Organization
Organization Name:DMV FAMILY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-662-1947
Mailing Address - Street 1:111 CHINA GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-3850
Mailing Address - Country:US
Mailing Address - Phone:571-662-1947
Mailing Address - Fax:
Practice Address - Street 1:111 CHINA GROVE RD
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-3850
Practice Address - Country:US
Practice Address - Phone:571-662-1947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871220814Medicaid