Healthcare Provider Details

I. General information

NPI: 1013289784
Provider Name (Legal Business Name): COMPANION EXTRAORDINAIRE NURSING NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ENGLAND ST
ASHLAND VA
23005-2083
US

IV. Provider business mailing address

112 ENGLAND ST
ASHLAND VA
23005-2083
US

V. Phone/Fax

Practice location:
  • Phone: 804-752-2205
  • Fax: 804-752-3403
Mailing address:
  • Phone: 804-752-2205
  • Fax: 804-752-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0715000070
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0715000070
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0715000070
License Number StateVA

VIII. Authorized Official

Name: MRS. DAWN L BENINGHOVE
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 804-752-2205