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General NPI Number Information
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NPI Number | 1790657856
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Entity Type | Organization
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Legal Business Name | DEMERARA ACCESS ENTERPRISE LLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 275 HAVENS RD
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City | WYTHEVILLE
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State | VA
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Zip | 24382-4519
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Country | US
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Telephone | 804-986-8143
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Fax | 866-230-2666
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Provider Business Mailing Address
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Address Line | 10004 BLUE STAR HWY
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City | STONY CREEK
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State | VA
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Zip | 23882-3218
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Country | US
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Telephone | 804-986-8143
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Fax | 866-230-2666
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Authorized Official
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Title or Position | PRESIDENT
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Name | EARL A BLACKMAN
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Credential |
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Telephone | 804-986-8143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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