Healthcare Provider Details

I. General information

NPI: 1356016448
Provider Name (Legal Business Name): COMPASSIONATE HANDS RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 SAPLING WAY
TRIANGLE VA
22172-2050
US

IV. Provider business mailing address

14401 HULFISH WAY
GAINESVILLE VA
20155-1668
US

V. Phone/Fax

Practice location:
  • Phone: 571-316-9075
  • Fax:
Mailing address:
  • Phone: 571-316-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: AMELIA WILMORE-NOZIL
Title or Position: CEO
Credential:
Phone: 571-316-9075