Healthcare Provider Details

I. General information

NPI: 1346175916
Provider Name (Legal Business Name): PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 GOLD HILL ELEMENTARY SCHOOL RD STE C
NEW CANTON VA
23123-2162
US

IV. Provider business mailing address

9294 WARWICK BLVD
NEWPORT NEWS VA
23607-1535
US

V. Phone/Fax

Practice location:
  • Phone: 434-581-4905
  • Fax: 434-581-4902
Mailing address:
  • Phone: 757-223-7016
  • Fax: 757-223-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAVONDA CYPRESS
Title or Position: COO
Credential:
Phone: 757-223-7016