Healthcare Provider Details

I. General information

NPI: 1487261921
Provider Name (Legal Business Name): CHANTRISE N RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTRISE RATLIFF C.K. PROFESSIONAL GR

II. Dates (important events)

Enumeration Date: 09/29/2020
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

553 JESSICA CIR
NEWPORT NEWS VA
23606-3761
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 Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number8203
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number8203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: