Healthcare Provider Details

I. General information

NPI: 1053193003
Provider Name (Legal Business Name): SIMPLY EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 BAY CIR
SUFFOLK VA
23435-2718
US

IV. Provider business mailing address

5025 BAY CIR
SUFFOLK VA
23435-2718
US

V. Phone/Fax

Practice location:
  • Phone: 480-319-0043
  • Fax:
Mailing address:
  • Phone: 480-319-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: SHANECKA DINKINS
Title or Position: OWNER
Credential:
Phone: 480-319-0043