=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821781865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMH OF VIRGINIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2023
-----------------------------------------------------
Last Update Date | 11/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 SANTA ROSA RD RM 109
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-822-5660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3819 BETHESDA CT
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23831-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-822-5660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEVEN RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-822-5660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------