Healthcare Provider Details

I. General information

NPI: 1164964557
Provider Name (Legal Business Name): 1ST IMPRESSION HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 BETHESDA CT
CHESTER VA
23831-1347
US

IV. Provider business mailing address

3812 BETHESDA CT
CHESTER VA
23831-1347
US

V. Phone/Fax

Practice location:
  • Phone: 804-715-8066
  • Fax: 804-295-5947
Mailing address:
  • Phone: 804-715-8066
  • Fax: 804-295-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-171528
License Number StateVA

VIII. Authorized Official

Name: DR. JOHN A ORISASONA
Title or Position: ADMINISTRATOR
Credential: P.HD
Phone: 804-715-8066