MEDICARE: HELPING HANDS OF VIRGINIA, LLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	2020-01-001	VA

General Provider Information

NPI Number	:	1982026704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING HANDS OF VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	1604 PINE VIEW CIR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4850
Country	:	US
Telephone Number	:	804-892-2859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 PINE VIEW CIR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4850
Country	:	US
Telephone Number	:	804-892-2859
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEAN FEDNEL DORSAINVILLE
Credential	:
Telephone Number	:	804-892-2859

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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