Healthcare Provider Details

I. General information

NPI: 1023579711
Provider Name (Legal Business Name): OPEN HEARTS RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 INDIAN RIVER RD # 38
CHESAPEAKE VA
23325-3100
US

IV. Provider business mailing address

4310 INDIAN RIVER RD # 38
CHESAPEAKE VA
23325-3100
US

V. Phone/Fax

Practice location:
  • Phone: 757-713-2994
  • Fax: 757-215-4063
Mailing address:
  • Phone: 757-232-7807
  • Fax: 757-215-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: TRACY BRADSHAW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-232-7807