Healthcare Provider Details

I. General information

NPI: 1467242370
Provider Name (Legal Business Name): TIMELESS DEDICATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 MIDLOTHIAN TPKE STE 318
NORTH CHESTERFIELD VA
23235-5291
US

IV. Provider business mailing address

8014 MIDLOTHIAN TPKE STE 318
NORTH CHESTERFIELD VA
23235-5291
US

V. Phone/Fax

Practice location:
  • Phone: 804-866-7050
  • Fax: 804-560-5567
Mailing address:
  • Phone: 804-866-7050
  • Fax: 804-560-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JAQUELL WILSON
Title or Position: OWNER
Credential:
Phone: 804-866-7050