Healthcare Provider Details

I. General information

NPI: 1760465033
Provider Name (Legal Business Name): STAMPER'S HEALTH ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N MAIN ST
RURAL RETREAT VA
24368-3123
US

IV. Provider business mailing address

PO BOX 257
RURAL RETREAT VA
24368-0257
US

V. Phone/Fax

Practice location:
  • Phone: 276-686-6321
  • Fax: 276-686-6160
Mailing address:
  • Phone: 276-686-6321
  • Fax: 276-686-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0562-15
License Number StateVA

VIII. Authorized Official

Name: JOY STAMPER
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 276-686-6321