Provider Demographics
NPI:1063942290
Name:RASPBERRY HILL ADULT DAYTIME CENTER
Entity type:Organization
Organization Name:RASPBERRY HILL ADULT DAYTIME CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-525-4422
Mailing Address - Street 1:1381 CROSSINGS CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4971
Mailing Address - Country:US
Mailing Address - Phone:434-525-4422
Mailing Address - Fax:434-534-3460
Practice Address - Street 1:1381 CROSSINGS CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4971
Practice Address - Country:US
Practice Address - Phone:434-525-4422
Practice Address - Fax:434-534-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212629163W00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty