=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750035903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABOVE AND BEYOND HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2022
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 S HOLLY AVE
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-573-3613
-----------------------------------------------------
Fax | 804-636-6143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 S HOLLY AVE
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-573-3613
-----------------------------------------------------
Fax | 804-636-6143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. EBONY D JOHNSON
-----------------------------------------------------
Credential | MW, LCSW
-----------------------------------------------------
Telephone | 804-366-9360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------