=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548580400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A DAB OF HOPE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2010
-----------------------------------------------------
Last Update Date | 06/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22906 PHEASANT CT
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-8411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-863-0322
-----------------------------------------------------
Fax | 804-863-1388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22906 PHEASANT CT
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-8411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-863-0322
-----------------------------------------------------
Fax | 804-863-1388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MRS. MARGARET LEWIS DABNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-863-0322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 1370
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------