MEDICARE: HELPING HANDS SUPPORTIVE 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

General Provider Information

NPI Number	:	1346709615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING HANDS SUPPORTIVE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1716 E HUNDRED RD STE 103
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-3301
Country	:	US
Telephone Number	:	804-454-0038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 E HUNDRED RD STE 103
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-3301
Country	:	US
Telephone Number	:	804-454-0038
Fax Number	:	804-454-0038

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	FAYESHON DAVIDSON
Credential	:	MS, BA, QMHP
Telephone Number	:	804-454-0038

Provider Enumeration Date	:	03/17/2019
Last Update Date	:	01/29/2020

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