Healthcare Provider Details

I. General information

NPI: 1417511148
Provider Name (Legal Business Name): ANNOINTED HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 ROBERT E LEE DR
NORTH PRINCE GEORGE VA
23860-7522
US

IV. Provider business mailing address

PO BOX 3123
PETERSBURG VA
23805-3123
US

V. Phone/Fax

Practice location:
  • Phone: 804-324-6507
  • Fax: 804-352-5364
Mailing address:
  • Phone: 804-324-6507
  • Fax: 804-352-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW L EDMONDS
Title or Position: CEO
Credential:
Phone: 804-324-6507