Provider Demographics
NPI:1679923544
Name:ACCESS FAMILY CARE OF SOUTHWEST VIRGINIA
Entity type:Organization
Organization Name:ACCESS FAMILY CARE OF SOUTHWEST VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-915-4835
Mailing Address - Street 1:709 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1203
Mailing Address - Country:US
Mailing Address - Phone:540-915-4835
Mailing Address - Fax:
Practice Address - Street 1:709 KENYON RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1203
Practice Address - Country:US
Practice Address - Phone:540-915-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24671251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management