Healthcare Provider Details

I. General information

NPI: 1609734052
Provider Name (Legal Business Name): GENERATIONAL HEALING HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6387 DOVE ST
NORFOLK VA
23513-3203
US

IV. Provider business mailing address

5014 PEARL ST
CHESAPEAKE VA
23321-1530
US

V. Phone/Fax

Practice location:
  • Phone: 757-462-6864
  • Fax: 510-323-7995
Mailing address:
  • Phone: 757-462-6864
  • Fax: 510-323-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DEVONIKA NICOLE GRAVES
Title or Position: OWNER
Credential:
Phone: 757-462-6864