MEDICARE: DOMINION DAY INTENSIVE IN-HOME SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	101YM0800X	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073740965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION DAY INTENSIVE IN-HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	2530 MERIDIAN PKWY
Second Line	:	SUITE 3077
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY
Second Line	:	SUITE 3077
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	804-519-4485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. RASHEEDE TENAYE HICKS
Credential	:
Telephone Number	:	804-519-4485

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/17/2009

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