Healthcare Provider Details

I. General information

NPI: 1033901350
Provider Name (Legal Business Name): ABC SUPPORTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 TIDEWATER DR
NORFOLK VA
23504-2827
US

IV. Provider business mailing address

1499 TIDEWATER DR
NORFOLK VA
23504-2827
US

V. Phone/Fax

Practice location:
  • Phone: 757-343-1683
  • Fax: 757-512-6251
Mailing address:
  • Phone: 757-679-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE WIMBISH
Title or Position: CEO
Credential: ADMINTRATOR
Phone: 757-679-0654