Provider Demographics
NPI:1083221113
Name:ANN RESIDENTIAL LLC
Entity Type:Organization
Organization Name:ANN RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAGIR
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:ELDIMYATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-924-5164
Mailing Address - Street 1:1916 N PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4023
Mailing Address - Country:US
Mailing Address - Phone:804-924-5164
Mailing Address - Fax:
Practice Address - Street 1:1916 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4023
Practice Address - Country:US
Practice Address - Phone:804-924-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty