1528134418 NPI number — LILLIES IN THE VALLEY PRIVATE DUTY SERVICES, LLC

Table of content: NKHONDO O NKUNIKA NP (NPI 1528536364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528134418 NPI number — LILLIES IN THE VALLEY PRIVATE DUTY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LILLIES IN THE VALLEY PRIVATE DUTY SERVICES, LLC
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:
1528134418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
546 DENBIGH BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23608-4240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-873-0711
Provider Business Mailing Address Fax Number:
757-873-0744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 DENBIGH BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23608-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-873-0711
Provider Business Practice Location Address Fax Number:
757-873-0744
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIX
Authorized Official First Name:
YVETTE
Authorized Official Middle Name:
VONCENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-873-0711

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HCO07332 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HCO-09332 , 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: 010354901 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102510952 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102419873 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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