Provider Demographics
NPI:1013584390
Name:HOME STAFFING SOLUTIONS LLC
Entity Type:Organization
Organization Name:HOME STAFFING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:757-706-4584
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-0245
Mailing Address - Country:US
Mailing Address - Phone:757-706-4584
Mailing Address - Fax:
Practice Address - Street 1:1451 GEORGE WASHINGTON MEMORIAL HWY # 245
Practice Address - Street 2:
Practice Address - City:GLOUCESTER POINT
Practice Address - State:VA
Practice Address - Zip Code:23062-2028
Practice Address - Country:US
Practice Address - Phone:757-706-4584
Practice Address - Fax:855-208-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104319227Medicaid