Healthcare Provider Details

I. General information

NPI: 1912337940
Provider Name (Legal Business Name): OPULENT SPRINGS RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 JEFFERSON DAVIS HWY
SOUTH CHESTERFIELD VA
23834-5338
US

IV. Provider business mailing address

17301 JEFFERSON DAVIS HWY
SOUTH CHESTERFIELD VA
23834-5338
US

V. Phone/Fax

Practice location:
  • Phone: 804-432-9096
  • Fax: 804-275-5412
Mailing address:
  • Phone: 804-432-9096
  • Fax: 804-275-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. SYLVIA BERNETTA JONES
Title or Position: VP-DEVELOPMENT
Credential:
Phone: 804-836-2089