MEDICARE: MCDOLE PERSONAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396224846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDOLE PERSONAL CARE LLC

Provider Business Mailing Address
First Line	:	4500 COLLEY AVE STE J
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2031
Country	:	US
Telephone Number	:	757-230-0341
Fax Number	:	757-257-0321

Provider Business Practice Location Address
First Line	:	4500 COLLEY AVE STE J
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2031
Country	:	US
Telephone Number	:	757-230-0341
Fax Number	:	757-257-0321

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CATRINA BANKS
Credential	:
Telephone Number	:	757-230-0341

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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Directions to “MCDOLE PERSONAL CARE LLC ” Practice Location

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