Healthcare Provider Details

I. General information

NPI: 1396067096
Provider Name (Legal Business Name): CDA HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LEWIS RD
PORTSMOUTH VA
23701-1326
US

IV. Provider business mailing address

208 LEWIS RD
PORTSMOUTH VA
23701-1326
US

V. Phone/Fax

Practice location:
  • Phone: 757-570-1861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. HARRELL J PITTMAN JR.
Title or Position: PRESIDENT
Credential:
Phone: 757-570-1861