Healthcare Provider Details

I. General information

NPI: 1780504415
Provider Name (Legal Business Name): SOULFUL & TIDY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 LENS AVE
NORFOLK VA
23509-2608
US

IV. Provider business mailing address

3220 LENS AVE
NORFOLK VA
23509-2608
US

V. Phone/Fax

Practice location:
  • Phone: 757-709-9852
  • Fax:
Mailing address:
  • Phone: 757-709-9852
  • Fax:

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: SANISE JADLYNE RAYMOND
Title or Position: OWNER
Credential:
Phone: 757-709-9852