MEDICARE: SIGNATURE NURSING AT HOME

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	0001254643	VA
2	251E00000X	Home Health Agency	0001254643	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700372216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE NURSING AT HOME

Provider Business Mailing Address
First Line	:	5340 GLENVILLE CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5440
Country	:	US
Telephone Number	:	757-797-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	638 INDEPENDENCE PKWY STE 240
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-5222
Country	:	US
Telephone Number	:	757-797-4334
Fax Number	:	757-842-4839

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	SONIA BARNETT-KETTER
Credential	:
Telephone Number	:	757-797-4334

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	03/24/2020

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