Healthcare Provider Details

I. General information

NPI: 1881436442
Provider Name (Legal Business Name): MCKENZIE RESIDENTIAL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 HARWICH DR
CHESAPEAKE VA
23322-9535
US

IV. Provider business mailing address

1038 CHARITY DR
VIRGINIA BEACH VA
23455-6131
US

V. Phone/Fax

Practice location:
  • Phone: 757-376-5446
  • Fax:
Mailing address:
  • Phone: 757-376-5446
  • Fax:

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: ADA MCKENZIE
Title or Position: OWNER
Credential:
Phone: 757-376-5446