Provider Demographics
NPI:1932404233
Name:DIVERSITY INHOME SUPPORTS, LLC
Entity Type:Organization
Organization Name:DIVERSITY INHOME SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-405-4000
Mailing Address - Street 1:9301 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1424
Mailing Address - Country:US
Mailing Address - Phone:804-405-4000
Mailing Address - Fax:804-608-8822
Practice Address - Street 1:9301 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-1424
Practice Address - Country:US
Practice Address - Phone:804-405-4000
Practice Address - Fax:804-608-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA702-01-011253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care