Healthcare Provider Details

I. General information

NPI: 1235953357
Provider Name (Legal Business Name): BELMONT DAY SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11073 COLONEL ARMISTEAD DR STE 101
RUTHER GLEN VA
22546-3367
US

IV. Provider business mailing address

11073 COLONEL ARMISTEAD DR STE 101
RUTHER GLEN VA
22546-3367
US

V. Phone/Fax

Practice location:
  • Phone: 757-560-9507
  • Fax:
Mailing address:
  • Phone: 757-560-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TENISHA STEPHEN
Title or Position: OWNER
Credential:
Phone: 804-940-6671