Healthcare Provider Details

I. General information

NPI: 1376478396
Provider Name (Legal Business Name): PROFESSIONAL HOME CARE OF VIRGINIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 COLLEY AVE STE 108
NORFOLK VA
23508-2166
US

IV. Provider business mailing address

5215 COLLEY AVE STE 108
NORFOLK VA
23508-2166
US

V. Phone/Fax

Practice location:
  • Phone: 757-231-5538
  • Fax: 757-299-9976
Mailing address:
  • Phone: 757-231-5538
  • Fax: 757-299-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEDRA DICKENS
Title or Position: PRESIDENT
Credential:
Phone: 757-231-5538