MEDICARE: A FAMILY IS ETERNAL

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1699488494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FAMILY IS ETERNAL

Provider Business Mailing Address
First Line	:	1889 S SYCAMORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2730
Country	:	US
Telephone Number	:	804-605-9845
Fax Number	:	804-895-7853

Provider Business Practice Location Address
First Line	:	1889 S SYCAMORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2730
Country	:	US
Telephone Number	:	804-605-9845
Fax Number	:	804-895-7853

Authorized Official
Title or Position	:	MANAGER
Name	:	NITA VIANN RANDOLPH DAVISON
Credential	:
Telephone Number	:	804-552-1397

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

Similar Medicare Providers

1851254098 — M & M BEHAVIORAL HEALTH SERVICES, LLC
Practice Location Address:

1879 S SYCAMORE ST
PETERSBURG, VA
23805-2730

Practice Phone: 804-926-9372
Practice Fax:

1376843698 — MRS. SHAHNEESE WRIGHT HALL LPC
Practice Location Address:

1889 S SYCAMORE ST
PETERSBURG, VA
23805-2730

Practice Phone: 804-552-1397
Practice Fax:

1174934921 — NITA VIANN RANDOLPH DAVISON
Practice Location Address:

1889 S SYCAMORE ST
PETERSBURG, VA
23805-2730

Practice Phone: 804-605-9845
Practice Fax: 804-895-7853

1871699587 — MS. EILEEN LUCY OCONNELL LCSW
Practice Location Address:

2730 CENTRAL AVENUE
ST PETERSBURG, FL
33712

Practice Phone: 727-742-7902
Practice Fax: 727-327-3759

1275751158 — MR. BENJAMIN TERRELL RAY LMT
Practice Location Address:

2730 CENTRAL AVE
ST PETERSBURG, FL
33712-1153

Practice Phone: 727-420-8293
Practice Fax:

1891990115 — DR. RICHARD DOUGLAS REITZ DC
Practice Location Address:

7893 9TH AVE S
ST PETERSBURG, FL
33707-2730

Practice Phone: 727-408-0285
Practice Fax:

Directions to “A FAMILY IS ETERNAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.