Provider Demographics
NPI:1568603033
Name:OLD DOMINION MEDICAL STAFFING AGENCY LLC
Entity Type:Organization
Organization Name:OLD DOMINION MEDICAL STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-334-2418
Mailing Address - Street 1:PO BOX 3416
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-7416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:804-716-1931
Practice Address - Street 1:8541 ELM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1419
Practice Address - Country:US
Practice Address - Phone:804-303-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health