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General NPI Number Information
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NPI Number | 1407080484
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Entity Type | Organization
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Legal Business Name | HERITAGE ADULT DAY CARE SERVICES, INC.
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 9550 MIDLOTHIAN TPKE SUITE 106
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City | RICHMOND
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State | VA
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Zip | 23235-4900
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Country | US
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Telephone | 804-330-3600
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Fax | 804-330-3601
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Provider Business Mailing Address
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Address Line | PO BOX 28723
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City | RICHMOND
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State | VA
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Zip | 23228-8723
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Country | US
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Telephone | 804-330-3600
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Fax | 804-330-3601
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELAGIB ELBASHIR
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Credential |
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Telephone | 804-330-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | C1S0313
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License Number State | VA
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