1104342351 NPI number — RICHMOND GROUP HOME

Table of content: (NPI 1104342351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104342351 NPI number — RICHMOND GROUP HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND GROUP HOME
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:
RICHMOND HOME
Provider Other Organization Name Type Code:
3
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:
1104342351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12306 QUAIL OAK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23005-7871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-852-2847
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9174 RUTH WOOD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-852-2847
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADESO
Authorized Official First Name:
BESSEM
Authorized Official Middle Name:
OJONG
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-852-2847

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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