Healthcare Provider Details

I. General information

NPI: 1831795087
Provider Name (Legal Business Name): A DIFFERENT CLOCK AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 JACKSON AVE
CHESAPEAKE VA
23324-2416
US

IV. Provider business mailing address

1039 JACKSON AVE
CHESAPEAKE VA
23324-2416
US

V. Phone/Fax

Practice location:
  • Phone: 757-676-2986
  • Fax:
Mailing address:
  • Phone: 757-676-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: OTELIA M MCFARLAND
Title or Position: OWNER
Credential:
Phone: 757-676-2986