Provider Demographics
NPI:1548679202
Name:ADULT HEALTHCARE SERVICES - APPOMATTOX
Entity type:Organization
Organization Name:ADULT HEALTHCARE SERVICES - APPOMATTOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-869-5045
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-0111
Mailing Address - Country:US
Mailing Address - Phone:434-352-8000
Mailing Address - Fax:434-664-1377
Practice Address - Street 1:7631B RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-8679
Practice Address - Country:US
Practice Address - Phone:434-352-8000
Practice Address - Fax:434-664-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548679202Medicaid