Healthcare Provider Details

I. General information

NPI: 1346697067
Provider Name (Legal Business Name): ABBY & ANTONIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 HUNGARY RD SUITE C
HENRICO VA
23228-2052
US

IV. Provider business mailing address

2915 HUNGARY RD SUITE C
HENRICO VA
23228-2052
US

V. Phone/Fax

Practice location:
  • Phone: 804-755-4424
  • Fax: 804-755-4427
Mailing address:
  • Phone: 804-755-4424
  • Fax: 804-755-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2931
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number2931
License Number StateVA

VIII. Authorized Official

Name: ABBY LYNN DICKSON
Title or Position: PRESIDENT
Credential:
Phone: 804-755-4424