Healthcare Provider Details

I. General information

NPI: 1669030920
Provider Name (Legal Business Name): LIVING A BLESSED LIFE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 N FIRST STREET
HAMPTON VA
23664
US

IV. Provider business mailing address

364 N FIRST STREET
HAMPTON VA
23664
US

V. Phone/Fax

Practice location:
  • Phone: 757-327-1267
  • Fax:
Mailing address:
  • Phone: 757-327-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA HILLIARD JACKSON
Title or Position: MANGER
Credential:
Phone: 757-327-1267