Healthcare Provider Details

I. General information

NPI: 1700372216
Provider Name (Legal Business Name): SIGNATURE NURSING AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 INDEPENDENCE PKWY STE 240
CHESAPEAKE VA
23320-5222
US

IV. Provider business mailing address

5340 GLENVILLE CIR
VIRGINIA BEACH VA
23464-5440
US

V. Phone/Fax

Practice location:
  • Phone: 757-797-4334
  • Fax: 757-842-4839
Mailing address:
  • Phone: 757-797-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0001254643
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0001254643
License Number StateVA

VIII. Authorized Official

Name: SONIA BARNETT-KETTER
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 757-797-4334