MEDICARE: LOVING HANDS SUPPORT CARE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1902739501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING HANDS SUPPORT CARE

Provider Business Mailing Address
First Line	:	4308 MCILWAINE DR
Second Line	:
City	:	N DINWIDDIE
State	:	VA
Zip	:	23803-9412
Country	:	US
Telephone Number	:	757-994-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 ALASKA DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3107
Country	:	US
Telephone Number	:	757-994-2384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASIAH JACKSON
Credential	:	RN
Telephone Number	:	757-994-2384

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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