Provider Demographics
NPI:1447524186
Name:PRISCILLA L BERRY
Entity type:Organization
Organization Name:PRISCILLA L BERRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:ELDER CARE AIDE
Authorized Official - Phone:703-729-3787
Mailing Address - Street 1:22350 DOLOMITE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7166
Mailing Address - Country:US
Mailing Address - Phone:703-729-3787
Mailing Address - Fax:
Practice Address - Street 1:22350 DOLOMITE HILLS DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-7166
Practice Address - Country:US
Practice Address - Phone:703-729-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health