Healthcare Provider Details

I. General information

NPI: 1467201285
Provider Name (Legal Business Name): CMRS HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 W 21ST ST # M
NORFOLK VA
23517
US

IV. Provider business mailing address

957 W 21ST ST # M
NORFOLK VA
23517
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-9128
  • Fax: 757-937-9152
Mailing address:
  • Phone: 901-246-0609
  • Fax: 757-937-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. ILETHA MILLER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential: DBA
Phone: 901-246-0609