Healthcare Provider Details

I. General information

NPI: 1831286806
Provider Name (Legal Business Name): SISTER'S PLACE GROUP HOME II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10204 SPINNING WHEEL WAY
RICHMOND VA
23233-2750
US

IV. Provider business mailing address

10204 SPINNING WHEEL WAY
RICHMOND VA
23233-2750
US

V. Phone/Fax

Practice location:
  • Phone: 804-290-0216
  • Fax: 804-290-0427
Mailing address:
  • Phone: 804-290-0216
  • Fax: 804-290-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number287-2006
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBORAH MALONE RALPH
Title or Position: CEO
Credential: L.C.S.W.
Phone: 804-290-0216