Provider Demographics
NPI:1982712295
Name:OLD DOMINION HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:OLD DOMINION HOME HEALTH SERVICES
Other - Org Name:OLD DOMINION SUPPLY AND EQUIPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-745-5133
Mailing Address - Street 1:8014 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5291
Mailing Address - Country:US
Mailing Address - Phone:804-745-5133
Mailing Address - Fax:804-745-5526
Practice Address - Street 1:8014 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-745-5133
Practice Address - Fax:804-745-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA608251E00000X
VA0206008463332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008772096Medicaid
VA280760OtherSOUTHERN HEALTH
VA004947762Medicaid
VA1018808OtherACM HOME HEALTH
VA286831OtherDME ANTHEM
VA0007049182OtherAETNA HOME HEALTH
VA008751242Medicaid
VA009116982Medicaid
VA004974683Medicaid
VA227295OtherANTHEM HOME HEALTH
VA008700206Medicaid
VA008773351Medicaid
VA010104076Medicaid
VA008704414Medicaid
VA1018807OtherACM HOME HEALTH
VA204160OtherSOUTHERN HEALTH
VA286831OtherDME ANTHEM
VA008772096Medicaid
VA008773351Medicaid
VA008751242Medicaid