Provider Demographics
NPI:1326570102
Name:ALLY HEALTH SERVICES
Entity Type:Organization
Organization Name:ALLY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-338-4857
Mailing Address - Street 1:3642 BROADWATER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1784
Mailing Address - Country:US
Mailing Address - Phone:804-338-4857
Mailing Address - Fax:
Practice Address - Street 1:3642 BROADWATER RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1784
Practice Address - Country:US
Practice Address - Phone:804-338-4857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0183377545Medicaid