Illuminated Direction
Health Maintenance Organization in Springfield, VA. Organization (NPI-2).
NPI number1780102335
StatusActive
Last updated in NPPESSep 5, 2017
Details
- NPI
- 1780102335
- Entity type
- Organization (NPI-2)
- Legal business name
- Illuminated Direction
- Organization subpart
- No
- Enumeration date
- Sep 5, 2017
- Last updated
- Sep 5, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302R00000X | Health Maintenance Organization | – | – | Yes |
Practice location
6116 Rolling Road Suite 104Springfield, VA 22152
Phone 571-730-8445 · Fax 888-227-5443
Mailing address
6116 Rolling Road Suite 104Springfield, VA 22152
Phone 571-730-8445 · Fax 888-227-5443
Authorized official
Jonathan Lacewell
Owner
9194527931
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