1982712295 NPI number — OLD DOMINION HOME HEALTH SERVICES

Table of content: (NPI 1982712295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982712295 NPI number — OLD DOMINION HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLD DOMINION HOME HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OLD DOMINION SUPPLY AND EQUIPMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982712295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8014 MIDLOTHIAN TPKE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-5291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-745-5133
Provider Business Mailing Address Fax Number:
804-745-5526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8014 MIDLOTHIAN TPKE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-5291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-745-5133
Provider Business Practice Location Address Fax Number:
804-745-5526
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILLIARD
Authorized Official First Name:
ISABELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
804-745-5133

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  608 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 0206008463 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008772096 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280760 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004947762 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018808 . This is a "ACM HOME HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 286831 . This is a "DME ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007049182 . This is a "AETNA HOME HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008751242 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009116982 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004974683 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227295 . This is a "ANTHEM HOME HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008700206 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008773351 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010104076 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008704414 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018807 . This is a "ACM HOME HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 204160 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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