Healthcare Provider Details

I. General information

NPI: 1891604625
Provider Name (Legal Business Name): OCTNINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BOUSH ST STE 200
NORFOLK VA
23510-1531
US

IV. Provider business mailing address

3419 VIRGINIA BEACH BLVD # 781
VA BEACH VA
23452-4419
US

V. Phone/Fax

Practice location:
  • Phone: 213-674-3267
  • Fax:
Mailing address:
  • Phone: 213-674-3267
  • 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: TANIYA SMITH
Title or Position: OWNER/MEMBER
Credential: LPN
Phone: 213-674-3267