Healthcare Provider Details

I. General information

NPI: 1912705567
Provider Name (Legal Business Name): DISTANCE MEDICAL STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 CHANTILLY ST STE 1
RICHMOND VA
23230-3513
US

IV. Provider business mailing address

1806 CHANTILLY ST STE 1
RICHMOND VA
23230-3513
US

V. Phone/Fax

Practice location:
  • Phone: 571-300-4200
  • Fax:
Mailing address:
  • Phone: 571-300-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS ASHLEY MEGGIE
Title or Position: OWNER
Credential:
Phone: 571-300-4200