Healthcare Provider Details

I. General information

NPI: 1013698893
Provider Name (Legal Business Name): FAMILY 1ST OF VIRGINIA HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 PEMBERTON RD STE 306
HENRICO VA
23238-4474
US

IV. Provider business mailing address

1403 PEMBERTON RD STE 306
HENRICO VA
23238-4474
US

V. Phone/Fax

Practice location:
  • Phone: 804-416-6831
  • Fax: 804-416-6823
Mailing address:
  • Phone: 804-416-6831
  • Fax: 804-416-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES THOMAS GOUGH JR.
Title or Position: OWNER/ADMINSTRATOR
Credential:
Phone: 804-986-6431