Healthcare Provider Details

I. General information

NPI: 1629692884
Provider Name (Legal Business Name): ARISE AND SHINE MISSION INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 WALL STREET BLDG. A SUITE #109
RICHMOND VA
23224-2322
US

IV. Provider business mailing address

PO BOX 26086
RICHMOND VA
23260-6086
US

V. Phone/Fax

Practice location:
  • Phone: 804-304-7482
  • Fax:
Mailing address:
  • Phone: 804-304-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: HENRY CHARLES MUKUYE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 804-304-7482