MEDICARE: HAGIR HASSAN SULIMAN ELDMIYATI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility		VA

General Provider Information

NPI Number	:	1184262602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAGIR HASSAN SULIMAN ELDMIYATI

Provider Business Mailing Address
First Line	:	1916 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4023
Country	:	US
Telephone Number	:	804-908-1914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4023
Country	:	US
Telephone Number	:	804-908-1914
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	12/16/2019

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