CCN: 497741 NPI: 1528449055 Organization

MYPOTENTIAL AT HOME

320 WESTSIDE STATION DR
WINCHESTER, VA 226012839

Contact Information

Phone 5404500343
Fax 5407230858
Enumeration Date 2015-06-10
Last Updated 2015-06-10

Taxonomies

Code: 251E00000X (Primary) License State: VA License: HCO-151094

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 6

providerType 36

censusDivision 6

providerType 36

censusDivision 6

providerType 36

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 49020

providerType 36

specialPaymentIndicator

carrierCode 11302

localityCode 00