Healthcare Provider Details

I. General information

NPI: 1215856224
Provider Name (Legal Business Name): KAISON PASSIONATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S 7TH ST
SUFFOLK VA
23434-3523
US

IV. Provider business mailing address

112 S 7TH ST
SUFFOLK VA
23434-3523
US

V. Phone/Fax

Practice location:
  • Phone: 948-225-1069
  • Fax: 948-225-1069
Mailing address:
  • Phone: 948-225-1069
  • Fax: 948-225-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KHADJI HAWKINS
Title or Position: OWNER
Credential:
Phone: 948-225-1069