Provider Demographics
NPI:1306249347
Name:UNITED SUPPORTIVE SERVICES OF VIRGINIA LLC
Entity type:Organization
Organization Name:UNITED SUPPORTIVE SERVICES OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REDD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-359-0613
Mailing Address - Street 1:1510 WILLOW LAWN DR
Mailing Address - Street 2:100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3429
Mailing Address - Country:US
Mailing Address - Phone:804-359-0613
Mailing Address - Fax:804-359-0614
Practice Address - Street 1:1510 WILLOW LAWN DR
Practice Address - Street 2:100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-359-0613
Practice Address - Fax:804-359-0614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN RESIDENTIAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA229698251300000X, 253Z00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251300000XAgenciesLocal Education Agency (LEA)
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA229698OtherVIRGINIA DEPARTMENT OF AGING AND REHABILITATIVE SERVICES