Healthcare Provider Details

I. General information

NPI: 1114097532
Provider Name (Legal Business Name): SENTARA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 INDEPENDENCE PKWY SUITE 200
CHESAPEAKE VA
23320-5176
US

IV. Provider business mailing address

535 INDEPENDENCE PKWY SUITE 200
CHESAPEAKE VA
23320-5176
US

V. Phone/Fax

Practice location:
  • Phone: 757-553-3000
  • Fax: 757-382-4957
Mailing address:
  • Phone: 757-553-3000
  • Fax: 757-382-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number045615
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: PAUL GADEB
Title or Position: PRESIDENT, SENTARA ENTERPRISES
Credential:
Phone: 757-553-3000