Pedialac Nursing Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HCO 161444 Issued in VA

Legal business name

PEDIALAC NURSING SERVICES LLC

Doing business as

Pedialac Nursing Services

Practice address

1127 International Pkwy Ste 220
Fredericksbrg, VA 22406-1142

Phone

(540) 737-4010

Fax

(540) 737-4011

NPI assigned

May 6, 2016

Last updated

Oct 19, 2021By 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

Elizabeth Ama Clarke, RN

Title

Adminstrator

Phone

(540) 737-4010

Specialties & licenses 2

Addresses

Other names 1

• PEDIALAC NURSING SERVICES Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417303603. Details of each certification follow.

• CCN 497773 Home health agency · Active · Details

Home health agency certification: CCN 497773

Legal name

PEDIALAC NURSING SERVICES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Dec 2, 2020

Last certification

Dec 2, 2020

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Nov 25, 2015 in VA

Enrollment address

1127 International Pkwy
Ste 220
Fredericksburg, VA 22406-1142

Listed as

Pedialac Nursing Services LLCCCN 497773 · All quality measures

Ownership

Proprietary

Certified

Dec 2, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1417303603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 INTERNATIONAL PKWY STE 220",
            "city": "FREDERICKSBRG",
            "state": "VA",
            "postal_code": "224061142",
            "telephone_number": "540-737-4010",
            "fax_number": "540-737-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 INTERNATIONAL PKWY STE 220",
            "city": "FREDERICKSBRG",
            "state": "VA",
            "postal_code": "224061142",
            "telephone_number": "540-737-4010",
            "fax_number": "540-737-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIALAC NURSING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-06",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "AMA",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "540-737-4010",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": "HCO 161444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIALAC NURSING SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Fredericksbrg, VA
• Providers in Fredericksbrg, VA by specialty
• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.