Healthcare Provider Details

I. General information

NPI: 1629515929
Provider Name (Legal Business Name): CARE2 RESIDENTIAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 EDEN WAY N # 266
CHESAPEAKE VA
23320-2798
US

IV. Provider business mailing address

732 EDEN WAY N # 266
CHESAPEAKE VA
23320-2798
US

V. Phone/Fax

Practice location:
  • Phone: 757-739-0777
  • Fax:
Mailing address:
  • Phone: 757-739-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2585
License Number StateVA

VIII. Authorized Official

Name: ADRIAN BROWN
Title or Position: QIDP
Credential: S.W.
Phone: 757-739-0777