Healthcare Provider Details

I. General information

NPI: 1699259788
Provider Name (Legal Business Name): MOTHER & SONS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

620 ANNAKA LOOP
CHESAPEAKE VA
23323-2104
US

IV. Provider business mailing address

620 ANNAKA LOOP
CHESAPEAKE VA
23323-2104
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-7683
  • Fax:
Mailing address:
  • Phone: 757-541-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER FORTNEY
Title or Position: OWNER
Credential:
Phone: 757-541-7683