MEDICARE: IN MY HOME CARE SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1952258972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN MY HOME CARE SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	739 HIGH ST STE 122
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3425
Country	:	US
Telephone Number	:	757-405-7307
Fax Number	:	804-535-4699

Provider Business Practice Location Address
First Line	:	739 HIGH ST STE 122
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3425
Country	:	US
Telephone Number	:	757-405-7307
Fax Number	:	804-535-4699

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE DOMINIQUE WILLIAMS
Credential	:
Telephone Number	:	757-405-7307

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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