Provider Demographics
NPI:1528134418
Name:LILLIES IN THE VALLEY PRIVATE DUTY SERVICES, LLC
Entity type:Organization
Organization Name:LILLIES IN THE VALLEY PRIVATE DUTY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:VONCENT
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED NURSE AIDE
Authorized Official - Phone:757-873-0711
Mailing Address - Street 1:546 DENBIGH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4240
Mailing Address - Country:US
Mailing Address - Phone:757-873-0711
Mailing Address - Fax:757-873-0744
Practice Address - Street 1:546 DENBIGH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4240
Practice Address - Country:US
Practice Address - Phone:757-873-0711
Practice Address - Fax:757-873-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO07332251E00000X
VAHCO-09332251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010354901Medicaid
VA0102510952Medicaid
VA0102419873Medicaid