Provider Demographics
NPI:1831445626
Name:HEALTHCARE SERVICES 101, LLC
Entity type:Organization
Organization Name:HEALTHCARE SERVICES 101, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:MONTRELL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:757-809-3588
Mailing Address - Street 1:125 TYNES ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4624
Mailing Address - Country:US
Mailing Address - Phone:757-809-3588
Mailing Address - Fax:757-809-3599
Practice Address - Street 1:125 TYNES ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4624
Practice Address - Country:US
Practice Address - Phone:757-809-3588
Practice Address - Fax:757-809-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-13859251E00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0159940029Medicaid
VA0159939617Medicaid