Provider Demographics
NPI:1417049206
Name:PROFESSIONAL HEALTHCARE RESOURCES OF RICHMOND, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE RESOURCES OF RICHMOND, INC.
Other - Org Name:PROFESSIONAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-752-8700
Mailing Address - Street 1:7619 LITTLE RIVER TURNPIKE
Mailing Address - Street 2:STE. 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:703-752-8779
Practice Address - Street 1:1650 WILLOW LAWN DR.
Practice Address - Street 2:STE. 301
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-288-8686
Practice Address - Fax:804-288-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497579251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497579Medicare ID - Type UnspecifiedMEDICARE NUMBER