MEDICARE: HAMPTON ROADS HOME 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

General Provider Information

NPI Number	:	1730741331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMPTON ROADS HOME CARE LLC

Provider Business Mailing Address
First Line	:	957 W 21ST ST STE K
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	957 W 21ST ST STE K
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1536
Country	:	US
Telephone Number	:	757-672-8945
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA KANNON
Credential	:
Telephone Number	:	757-672-8945

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	05/14/2026

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