Healthcare Provider Details

I. General information

NPI: 1831445626
Provider Name (Legal Business Name): HEALTHCARE SERVICES 101, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 TYNES ST
SUFFOLK VA
23434-4624
US

IV. Provider business mailing address

125 TYNES ST
SUFFOLK VA
23434-4624
US

V. Phone/Fax

Practice location:
  • Phone: 757-809-3588
  • Fax: 757-809-3599
Mailing address:
  • Phone: 757-809-3588
  • Fax: 757-809-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberHCO-13859
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-13859
License Number StateVA

VIII. Authorized Official

Name: MRS. RAQUEL MONTRELL HARRIS
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 757-809-3588