MEDICARE: NORFOLK SENIOR 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	253Z00000X	In Home Supportive Care Agency	HCO17528	VA

General Provider Information

NPI Number	:	1699224295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	6040 E VIRGINIA BEACH BLVD
Second Line	:	SUITE B
City	:	NORFOLK
State	:	VA
Zip	:	23502-2474
Country	:	US
Telephone Number	:	757-228-3276
Fax Number	:	757-228-5832

Provider Business Practice Location Address
First Line	:	6040 E VIRGINIA BEACH BLVD
Second Line	:	SUITE B
City	:	NORFOLK
State	:	VA
Zip	:	23502-2474
Country	:	US
Telephone Number	:	757-228-3276
Fax Number	:	757-228-5832

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEVE M SECONDINO SR.
Credential	:
Telephone Number	:	757-228-3276

Provider Enumeration Date	:	09/25/2016
Last Update Date	:	09/25/2016

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