=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922489491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELPING HANDS ADULT CARE CENTER OF PETERSBURG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2015
-----------------------------------------------------
Last Update Date | 06/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 MCKEEVER ST
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-861-1353
-----------------------------------------------------
Fax | 804-862-2317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 MCKEEVER ST
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-861-1353
-----------------------------------------------------
Fax | 804-862-2317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. IRENE DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-861-1353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | ALF141103821
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number | ADC141103624
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------