Healthcare Provider Details

I. General information

NPI: 1255210415
Provider Name (Legal Business Name): CK PROFESSIONAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PENNINGTON AVE
NEWPORT NEWS VA
23606-2631
US

IV. Provider business mailing address

15 PENNINGTON AVE
NEWPORT NEWS VA
23606-2631
US

V. Phone/Fax

Practice location:
  • Phone: 757-513-0788
  • Fax:
Mailing address:
  • Phone: 757-513-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHANTRISE N RATLIFF
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-513-0788