IndividualActive
Derrick Mathis, ALFA
NPI 1780822841 · Nursing Home Administrator · Manassas, VA
Provider details
- NPI number
- 1780822841
- Entity type
- Individual
- Primary specialty
- Nursing Home AdministratorNursing Service Related Providers
- Credential
- ALFA
- Sex
- Male
- Sole proprietor
- Yes
- License
- 1706000192 (VA)
Specialties & taxonomies
Nursing Service Related Providers
Practice location
9827 Sudley Manor Dr
Manassas, VA 20109-6232
Phone: (703) 530-7751
Approximate (ZIP-level) locationGet directions
Mailing address
9827 Sudley Manor Dr
Manassas, VA 20109-6232
Registry dates
- Enumerated
- 2009-01-28
- Last updated
- 2009-01-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.