Healthcare Provider Details

I. General information

NPI: 1831414192
Provider Name (Legal Business Name): SENTARA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FETTLER PARK DR STE 102
DUMFRIES VA
22025-2045
US

IV. Provider business mailing address

535 INDEPENDENCE PKWY SUITE 200
CHESAPEAKE VA
23320-5176
US

V. Phone/Fax

Practice location:
  • Phone: 571-285-1820
  • Fax: 571-659-0697
Mailing address:
  • Phone: 757-553-3000
  • Fax: 757-382-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TERESA EDWARDS
Title or Position: PRESIDENT
Credential:
Phone: 757-553-3000