Provider Demographics
NPI:1104342351
Name:RICHMOND GROUP HOME
Entity type:Organization
Organization Name:RICHMOND GROUP HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BESSEM
Authorized Official - Middle Name:OJONG
Authorized Official - Last Name:ADESO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:804-852-2847
Mailing Address - Street 1:12306 QUAIL OAK CT
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7871
Mailing Address - Country:US
Mailing Address - Phone:804-852-2847
Mailing Address - Fax:
Practice Address - Street 1:9174 RUTH WOOD CT
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3903
Practice Address - Country:US
Practice Address - Phone:804-852-2847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-19
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities