Provider Demographics
NPI:1013359405
Name:THIMS GROUP HOME LLC
Entity Type:Organization
Organization Name:THIMS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHIE
Authorized Official - Middle Name:EUDEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MSHS
Authorized Official - Phone:757-345-0824
Mailing Address - Street 1:36 HAMPTON KY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5538
Mailing Address - Country:US
Mailing Address - Phone:757-345-0824
Mailing Address - Fax:757-345-0824
Practice Address - Street 1:36 HAMPTON KY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5538
Practice Address - Country:US
Practice Address - Phone:757-345-0824
Practice Address - Fax:757-345-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1925-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities