Provider Demographics
NPI:1922489491
Name:HELPING HANDS ADULT CARE CENTER OF PETERSBURG
Entity Type:Organization
Organization Name:HELPING HANDS ADULT CARE CENTER OF PETERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-861-1353
Mailing Address - Street 1:130 MCKEEVER ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4302
Mailing Address - Country:US
Mailing Address - Phone:804-861-1353
Mailing Address - Fax:804-862-2317
Practice Address - Street 1:130 MCKEEVER ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4302
Practice Address - Country:US
Practice Address - Phone:804-861-1353
Practice Address - Fax:804-862-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF1411038213104A0625X
VAADC141103624311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101267034Medicaid
VA0101043609Medicaid