Healthcare Provider Details

I. General information

NPI: 1700619962
Provider Name (Legal Business Name): EMERALD LIVING HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 BUSHNELL DR
NEW KENT VA
23124-3033
US

IV. Provider business mailing address

6130 BUSHNELL DR
NEW KENT VA
23124-3033
US

V. Phone/Fax

Practice location:
  • Phone: 757-218-1331
  • Fax:
Mailing address:
  • Phone: 757-218-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONTECIA BOYD BURNO
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 757-218-1331