Provider Demographics
NPI:1184262602
Name:ELDMIYATI, HAGIR HASSAN SULIMAN
Entity type:Individual
Prefix:
First Name:HAGIR
Middle Name:HASSAN SULIMAN
Last Name:ELDMIYATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 N PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4023
Mailing Address - Country:US
Mailing Address - Phone:804-908-1914
Mailing Address - Fax:
Practice Address - Street 1:1916 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4023
Practice Address - Country:US
Practice Address - Phone:804-908-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home