Provider Demographics
NPI:1376607473
Name:OLD DOMINION HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:OLD DOMINION HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-745-5133
Mailing Address - Street 1:8014 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5291
Mailing Address - Country:US
Mailing Address - Phone:804-745-5133
Mailing Address - Fax:804-745-5526
Practice Address - Street 1:8014 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 312
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-745-5133
Practice Address - Fax:804-745-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497513Medicare ID - Type UnspecifiedHOME HEALTH MEDICARE NUMB