Healthcare Provider Details

I. General information

NPI: 1659088169
Provider Name (Legal Business Name): AMAZING SKIES HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 INDIAN RIVER RD STE 2A
CHESAPEAKE VA
23325-3100
US

IV. Provider business mailing address

4310 INDIAN RIVER RD STE 2A
CHESAPEAKE VA
23325-3100
US

V. Phone/Fax

Practice location:
  • Phone: 757-998-3237
  • Fax:
Mailing address:
  • Phone: 757-998-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TANISHA CHURCH
Title or Position: OWNER
Credential:
Phone: 757-998-3237