Provider Demographics
NPI:1487655825
Name:I'M STILL ME, LLC
Entity type:Organization
Organization Name:I'M STILL ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-878-2136
Mailing Address - Street 1:5442 OLD ALEXANDRIA TPKE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-9360
Mailing Address - Country:US
Mailing Address - Phone:540-878-2136
Mailing Address - Fax:540-878-2137
Practice Address - Street 1:5442 OLD ALEXANDRIA TPKE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-9360
Practice Address - Country:US
Practice Address - Phone:540-878-2136
Practice Address - Fax:540-878-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010167388Medicaid
VA11492275OtherCAQH PROVIDER ID
VA5233220001Medicare NSC