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General NPI Number Information
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NPI Number | 1174124663
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Entity Type | Organization
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Legal Business Name | VETS AIDE
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 49 WALNUT BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805-2109
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Country | US
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Telephone | 804-721-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 3785 IMPALA DR
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1492
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Country | US
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Telephone | 804-721-7457
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. THOMAS EARL HARRELL JR.
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Credential |
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Telephone | 804-721-7457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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