MEDICARE: ANN RESIDENTIAL 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083221113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN RESIDENTIAL LLC

Provider Business Mailing Address
First Line	:	1916 N PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23229-4023
Country	:	US
Telephone Number	:	804-924-5164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 N PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23229-4023
Country	:	US
Telephone Number	:	804-924-5164
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAGIR HASSAN ELDIMYATI
Credential	:
Telephone Number	:	804-924-5164

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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Directions to “ANN RESIDENTIAL LLC ” Practice Location

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