Healthcare Provider Details

I. General information

NPI: 1982964292
Provider Name (Legal Business Name): QUALITY ADVANTAGE HOME PRODUCTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N ARMISTEAD AVE
HAMPTON VA
23669-3047
US

IV. Provider business mailing address

610 N ARMISTEAD AVE
HAMPTON VA
23669-3047
US

V. Phone/Fax

Practice location:
  • Phone: 757-728-3755
  • Fax: 757-728-3735
Mailing address:
  • Phone: 757-728-3755
  • Fax: 757-728-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2705 040492A
License Number StateVA

VIII. Authorized Official

Name: CHRISTOPHER BENTON SHENK
Title or Position: VICE PRESIDENT/GENERAL MANAGER
Credential:
Phone: 757-728-3755