Healthcare Provider Details

I. General information

NPI: 1992327555
Provider Name (Legal Business Name): PASSIONATE HEARTS HOME HEALTH AGENCY & SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 SELDEN AVE
NORFOLK VA
23523-2126
US

IV. Provider business mailing address

1122 SELDEN AVE
NORFOLK VA
23523-2126
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-4747
  • Fax:
Mailing address:
  • Phone: 757-414-4747
  • Fax:

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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONYA JENELLE FOGG
Title or Position: OWNER
Credential:
Phone: 757-414-4747