Healthcare Provider Details

I. General information

NPI: 1962935015
Provider Name (Legal Business Name): SELFLESS SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/05/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 E ELLERSLIE AVE STE C
COLONIAL HEIGHTS VA
23834
US

IV. Provider business mailing address

256 E ELLERSLIE AVE STE B
COLONIAL HEIGHTS VA
23834-1407
US

V. Phone/Fax

Practice location:
  • Phone: 804-805-2178
  • Fax: 804-805-2179
Mailing address:
  • Phone: 804-805-2178
  • Fax: 804-805-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCO-171611
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCO-181611
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID W. CONOLLY JR.
Title or Position: PRESIDENT/CEO
Credential: SFC(R)
Phone: 804-295-9585