Healthcare Provider Details

I. General information

NPI: 1104308626
Provider Name (Legal Business Name): GOWEM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 COLLEY AVE STE 112
NORFOLK VA
23508-2166
US

IV. Provider business mailing address

5215 COLLEY AVE STE 112
NORFOLK VA
23508-2166
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-0064
  • Fax: 757-257-3332
Mailing address:
  • Phone: 757-321-0064
  • Fax: 757-257-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-191887
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MCMAURICE CHINONSO NDUBUEZE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 757-300-7980