Provider Demographics
NPI:1164405825
Name:HEALTHCARE SOLUTIONS MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:HEALTHCARE SOLUTIONS MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-732-7625
Mailing Address - Street 1:116 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4511
Mailing Address - Country:US
Mailing Address - Phone:804-732-7625
Mailing Address - Fax:
Practice Address - Street 1:116 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4511
Practice Address - Country:US
Practice Address - Phone:804-732-7625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-26
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4973836Medicaid
VA4973836Medicaid