=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568852747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELCOME HOME COMMUNITY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 09/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 OWENS WAY STE 100-200
-----------------------------------------------------
City | PRINCE GEORGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23875-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-458-5500
-----------------------------------------------------
Fax | 804-458-5501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 247
-----------------------------------------------------
City | PRINCE GEORGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23875-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-458-5500
-----------------------------------------------------
Fax | 804-458-5501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. RUTHE PIERRE LAURORE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 804-255-7667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------