Healthcare Provider Details

I. General information

NPI: 1285819466
Provider Name (Legal Business Name): HOME SUITE HOMES RESIDENTIAL & ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10404 PATTERSON AVE SUITE 101
RICHMOND VA
23238-5128
US

IV. Provider business mailing address

PO BOX 36509
RICHMOND VA
23235-8010
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-3113
  • Fax:
Mailing address:
  • Phone: 804-539-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberS159012-6
License Number StateVA

VIII. Authorized Official

Name: MRS. FRANCINE WARD
Title or Position: OWNER
Credential:
Phone: 804-741-3001