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General NPI Number Information
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NPI Number | 1932404233
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Entity Type | Organization
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Legal Business Name | DIVERSITY INHOME SUPPORTS, LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 9301 HULL STREET RD
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City | RICHMOND
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State | VA
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Zip | 23236-1424
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Country | US
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Telephone | 804-405-4000
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Fax | 804-608-8822
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Provider Business Mailing Address
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Address Line | 9301 HULL STREET RD
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City | RICHMOND
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State | VA
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Zip | 23236-1424
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Country | US
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Telephone | 804-405-4000
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Fax | 804-608-8822
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. MICHELLE WHITTINGHAM
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Credential |
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Telephone | 804-405-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 702-01-011
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License Number State | VA
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