Healthcare Provider Details

I. General information

NPI: 1841722600
Provider Name (Legal Business Name): JENESYS HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 S CHURCH ST STE 6
SMITHFIELD VA
23430-1831
US

IV. Provider business mailing address

676 BATTLEFIELD BLVD N STE A
CHESAPEAKE VA
23320-0306
US

V. Phone/Fax

Practice location:
  • Phone: 757-356-0566
  • Fax: 757-356-0599
Mailing address:
  • Phone: 757-420-0566
  • Fax: 757-420-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO171051
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO171051
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO171051
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANTE HALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-420-0566