=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699536920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PERFECT HOME LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2024
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 BAINBRIDGE BLVD
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23324-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-937-1864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 BAINBRIDGE BLVD
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23324-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/QDDP
-----------------------------------------------------
Name | LEMUEL DANIELS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-535-9041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------