Healthcare Provider Details

I. General information

NPI: 1780306464
Provider Name (Legal Business Name): IMPERIAL TRANSITIONS HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 COLLEY AVE STE 135
NORFOLK VA
23508-2172
US

IV. Provider business mailing address

5215 COLLEY AVE STE 135
NORFOLK VA
23508-2172
US

V. Phone/Fax

Practice location:
  • Phone: 757-333-3109
  • Fax: 757-500-4578
Mailing address:
  • Phone: 757-333-3109
  • Fax: 757-500-4578

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: MR. MICHAEL DEAN JR.
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 757-472-4441