Provider Demographics
NPI:1023342870
Name:M & T UNIVERSAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:M & T UNIVERSAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AYONG
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, LPN
Authorized Official - Phone:571-830-6812
Mailing Address - Street 1:6315 BACKLICK RD STE 308
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2608
Mailing Address - Country:US
Mailing Address - Phone:571-830-6812
Mailing Address - Fax:571-830-6813
Practice Address - Street 1:6315 BACKLICK RD STE 308
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150
Practice Address - Country:US
Practice Address - Phone:571-830-6812
Practice Address - Fax:571-830-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-10596251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health