MEDICARE: DENISE ELAINE DEMERY

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1396113056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENISE ELAINE DEMERY

Provider Business Mailing Address
First Line	:	1723 HUNGARY RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2352
Country	:	US
Telephone Number	:	804-564-2304
Fax Number	:	804-564-2304

Provider Business Practice Location Address
First Line	:	1723 HUNGARY RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2352
Country	:	US
Telephone Number	:	804-564-2304
Fax Number	:	804-564-2304

Authorized Official
Title or Position	:	SERVICE FACILITATOR
Name	:	MS. DENISE ELAINE DEMERY
Credential	:
Telephone Number	:	804-564-2304

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	09/10/2015

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