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General NPI Number Information
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NPI Number | 1659894376
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Entity Type | Organization
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Legal Business Name | IMMANUEL RESIDENTIAL SERVICES LLC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1002 WEXFORD PLACE
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-509-9721
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 WEXFORD PL
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City | LYNCHBURG
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State | VA
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Zip | 24502-3221
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Country | US
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Telephone | 434-509-9721
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CANDICE CAGE
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Credential |
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Telephone | 434-509-9721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 26880
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License Number State | VA
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