Provider Demographics
NPI:1073740965
Name:DOMINION DAY INTENSIVE IN-HOME SERVICES, LLC
Entity Type:Organization
Organization Name:DOMINION DAY INTENSIVE IN-HOME SERVICES, LLC
Other - Org Name:DOMINION DAY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASHEEDE
Authorized Official - Middle Name:TENAYE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-519-4485
Mailing Address - Street 1:2530 MERIDIAN PKWY
Mailing Address - Street 2:SUITE 3077
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2530 MERIDIAN PKWY
Practice Address - Street 2:SUITE 3077
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5272
Practice Address - Country:US
Practice Address - Phone:804-519-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004944500Medicaid