Healthcare Provider Details

I. General information

NPI: 1598057085
Provider Name (Legal Business Name): YATES HOME REPAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16203 COURTHOUSE RD
DINWIDDIE VA
23841-3431
US

IV. Provider business mailing address

16203 COURTHOUSE RD
DINWIDDIE VA
23841-3431
US

V. Phone/Fax

Practice location:
  • Phone: 804-721-4176
  • Fax: 804-862-3700
Mailing address:
  • Phone: 804-721-4176
  • Fax: 804-862-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2705062531C
License Number StateVA

VIII. Authorized Official

Name: MR. KENNETH MICHAEL YATES
Title or Position: CONTRACTOR
Credential:
Phone: 804-721-4176