1467607580 NPI number — DOMINION WAIVER SERVICES

Table of content: (NPI 1467607580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467607580 NPI number — DOMINION WAIVER SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINION WAIVER 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:
Provider Other Organization Name Type Code:
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:
1467607580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23255-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-285-9838
Provider Business Mailing Address Fax Number:
804-285-9839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 WILMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23227-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-266-9012
Provider Business Practice Location Address Fax Number:
804-266-9022
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PULLIAM
Authorized Official First Name:
GL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF RESIDENTIAL
Authorized Official Telephone Number:
804-285-9838

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  40608011 , 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)

  • Identifier: 406-08-011 . This is a "DMHMRSAS LICENSE NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com