DAMON PETERSON (NPI# 1194042515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194042515 |
| Entity Type | Individual |
| Full Name | DAMON PETERSON |
| Credential | M.ED, PBSF |
| Practice Address |
24812 Brickwood Meadow Ln Petersburg VA 23803-8869 |
| Mailing Address |
Po Box 334 Petersburg VA 23804-0334 |
| Practice Telephone | 8048615201 |
| Mailing Telephone | 8048615201 |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2010-04-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 148 | VA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 0160289598 | 05 |
| Street Address |
24812 BRICKWOOD MEADOW LN |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23803-8869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619523719 | Wise Journey Ltd | Home Health | 325-b Brown Street Suite 132, Petersburg, VA 23803 | 2019-08-14 |
| 1386101699 | Marliqua Barnes | Driver | 601 Carter St, Petersburg, VA 23803 | 2019-02-22 |
| 1356596571 | Quality Healthcare Inc | Community/Behavioral Health | 6111 Duncan Rd, Ste F, Petersburg, VA 23803 | 2008-12-02 |
| 1861614943 | Peoples Family Dental Care | Dentist | 1328 W Washington St, Petersburg, VA 23803 | 2007-05-02 |
| 1841333721 | Family Preservation Services, Inc | Community/Behavioral Health | 1000 Patterson Ave, Petersburg, VA 23803 | 2007-02-14 |
| 1154473155 | Progressive Adult Rehabilitation Center, Inc. | Day Training, Developmentally Disabled Services | 114 North Union Street, Suite B, Petersburg, VA 23803 | 2007-01-18 |
| 1861556615 | Evelyn V. Whitehead | Counselor | 115 E Wythe St, Petersburg, VA 23803 | 2006-12-19 |
| 1538248778 | Raymond Gibson Smith Jr. | Dentist | Seventh Avenue, Hiram Davis Medical Center, Petersburg, VA 23803 | 2006-11-06 |
| 1396842282 | Eugene Arthur Richardson IIi | Dentist | 23 Shore Street, Petersburg, VA 23803 | 2006-09-20 |
| 1679594030 | Olumuyiwa Akinniyi Ojediran | Internal Medicine | 734 South Sycamore Street, Petersburg, VA 23803 | 2006-07-21 |
| Find all providers in zip 23803 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790340354 | Fobbs Family Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1618 Montpelier St, Petersburg, VA 23805-1329 | 2019-05-08 |
| 1306377114 | Harmony Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1586 Montpelier St, Petersburg, VA 23805-1331 | 2017-03-23 |
| 1679939169 | T'lab, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 823 S Jones St, Petersburg, VA 23803-4952 | 2016-01-13 |
| 1770988123 | Iveyhouse Ltd. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2222 Colston St, Petersburg, VA 23805-2204 | 2014-10-28 |
| 1982026704 | Helping Hands of Virginia, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1604 Pine View Cir, Petersburg, VA 23803-4850 | 2014-01-14 |
| 1093141517 | Heart To Heart Residential Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2115 N Whitehill Dr, Petersburg, VA 23803-3731 | 2013-09-16 |
| 1255677845 | Taylors Enhanced Living IIi Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3267 S Crater Rd, Petersburg, VA 23805-9216 | 2012-12-31 |
| 1548580400 | A Dab of Hope, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 22906 Pheasant Ct, Petersburg, VA 23803-8411 | 2010-06-02 |
| 1134374622 | Empty Arms Outreach Ministry, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4526 Brickwood Meadow Ct, Petersburg, VA 23803-8866 | 2008-11-25 |
| 1982677027 | Halo, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1857a Fort Mahone St, Petersburg, VA 23805-2761 | 2006-02-09 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23803 |
Please comment or provide details below to improve the information on DAMON PETERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.