Provider Demographics
NPI:1518434257
Name:FULL POCKET FARM LLC
Entity Type:Organization
Organization Name:FULL POCKET FARM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, QDDP
Authorized Official - Phone:804-366-4815
Mailing Address - Street 1:15094 HAWKS CLIMB LN
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2706
Mailing Address - Country:US
Mailing Address - Phone:804-366-4815
Mailing Address - Fax:804-366-4815
Practice Address - Street 1:15094 HAWKS CLIMB LN
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2706
Practice Address - Country:US
Practice Address - Phone:804-366-4815
Practice Address - Fax:804-366-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services