Healthcare Provider Details

I. General information

NPI: 1194477992
Provider Name (Legal Business Name): ADELLIET HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 WHITE CAP CRST
CHESAPEAKE VA
23321-3256
US

IV. Provider business mailing address

4243 WHITE CAP CRST
CHESAPEAKE VA
23321-3256
US

V. Phone/Fax

Practice location:
  • Phone: 757-905-7314
  • Fax:
Mailing address:
  • Phone: 757-905-7314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. WILLIET NGWEBENG MUBAH
Title or Position: ALTERNATE
Credential:
Phone: 757-768-1010