Healthcare Provider Details

I. General information

NPI: 1215534656
Provider Name (Legal Business Name): DSGB CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14341 GENERATION LN
CHESTERFIELD VA
23838-4200
US

IV. Provider business mailing address

14341 GENERATION LN
CHESTERFIELD VA
23838-4200
US

V. Phone/Fax

Practice location:
  • Phone: 804-243-4603
  • Fax:
Mailing address:
  • Phone: 804-243-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R BLANKENSHIP
Title or Position: PRESIDENT
Credential: OWNER
Phone: 804-243-4603