Justin's Black Tea and Bread, a Tea Room LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

JUSTIN'S BLACK TEA AND BREAD, A TEA ROOM LLC

Doing business as

Peoples Healthcare Facility

Practice address

1001 Providence St
Ste 203
Stafford, VA 22554-8300

Phone

(703) 589-5432

Fax

(540) 657-9732

NPI assigned

Oct 19, 2012

Last updated

Oct 19, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Justin Proctor

Title

President Ceo

Phone

(703) 589-5432

Specialties & licenses 1

Addresses

Other names 1

• Peoples Healthcare Facility Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1255684858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 PROVIDENCE ST",
            "address_2": "STE 203",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225548300",
            "telephone_number": "703-589-5432",
            "fax_number": "540-657-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 PROVIDENCE ST",
            "address_2": "STE 203",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225548300",
            "telephone_number": "703-589-5432",
            "fax_number": "540-657-9732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN'S BLACK TEA AND BREAD, A TEA ROOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-19",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "703-589-5432",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peoples Healthcare Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cooper James Jozwiak
• Jules a. Feledy, Jr., MD., PLLC (Belmont Plastic Surgery)
• Sosina Jules
• Christine Elizabeth Juliana, PA-C
• Junior Smiles of Stafford PLLC
• Hamed Kabiri, MD
• Shabir Ahmad Kabirzad
• Kaevora Healthcare Services LLC
• Trinity Hope Kahley-Mattingly
• Enamul Hoq Kahn, M.D.

• Health Service Clinic/Center in Stafford, VA
• Providers in Stafford, VA by specialty
• Health Service Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.