=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174708044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABLE HANDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4924 RAIL DR
-----------------------------------------------------
City | SANDSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23150-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-326-0554
-----------------------------------------------------
Fax | 804-326-0655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4924 RAIL DR
-----------------------------------------------------
City | SANDSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23150-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-326-0554
-----------------------------------------------------
Fax | 804-326-0655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTER NURSE
-----------------------------------------------------
Name | MR. JERRY WAYNE WADSWORTH
-----------------------------------------------------
Credential | B.S.N.
-----------------------------------------------------
Telephone | 804-326-0554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | W08002000
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------