Healthcare Provider Details

I. General information

NPI: 1013989276
Provider Name (Legal Business Name): HOLIDAY HOUSE OF PORTSMOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 COUNTY ST
PORTSMOUTH VA
23707-2512
US

IV. Provider business mailing address

4211 COUNTY ST
PORTSMOUTH VA
23707-2512
US

V. Phone/Fax

Practice location:
  • Phone: 757-397-6352
  • Fax: 757-399-2356
Mailing address:
  • Phone: 757-397-6352
  • Fax: 757-399-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMA BATSON MEGILL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 757-397-6352