MEDICARE: METRO GARDENS ENTERPRISES, INC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1871457770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO GARDENS ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	17 SHORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5818
Country	:	US
Telephone Number	:	804-732-1813
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SHORE ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5818
Country	:	US
Telephone Number	:	804-732-1813
Fax Number	:

Authorized Official
Title or Position	:	100 PERCENT OWNER
Name	:	CELESTINE DABIS HICKS
Credential	:
Telephone Number	:	804-731-6129

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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