Healthcare Provider Details

I. General information

NPI: 1962332189
Provider Name (Legal Business Name): HAVEN RISE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 TODDS LN STE 345
HAMPTON VA
23666-3209
US

IV. Provider business mailing address

4760 BISHOPS GATE WAY
PROVIDENCE FORGE VA
23140-4438
US

V. Phone/Fax

Practice location:
  • Phone: 804-773-9008
  • Fax:
Mailing address:
  • Phone: 804-773-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLITA LEWIS
Title or Position: PRESIDENT
Credential:
Phone: 804-773-9008