Healthcare Provider Details

I. General information

NPI: 1255806907
Provider Name (Legal Business Name): TINAS WORLD OF LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 CHURCH ST # C
NORFOLK VA
23504-2313
US

IV. Provider business mailing address

1751 CHURCH ST # C
NORFOLK VA
23504-2313
US

V. Phone/Fax

Practice location:
  • Phone: 757-500-4306
  • Fax: 757-628-1022
Mailing address:
  • Phone: 757-500-4306
  • Fax: 757-628-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERLEAN GREENE
Title or Position: DIRECTOR
Credential:
Phone: 757-500-4306