Healthcare Provider Details

I. General information

NPI: 1255741427
Provider Name (Legal Business Name): COMPANION OF LOVE HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MARKET ST STE 104
SUFFOLK VA
23434-5249
US

IV. Provider business mailing address

605 COUNTY ST
SUFFOLK VA
23434-4727
US

V. Phone/Fax

Practice location:
  • Phone: 757-925-3711
  • Fax: 757-925-4220
Mailing address:
  • Phone: 757-925-3711
  • Fax: 757-925-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0001173248
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0001173248
License Number StateVA

VIII. Authorized Official

Name: MRS. RHONDA DAWN SKINNER
Title or Position: ADMINISTRATOR
Credential: PCA
Phone: 757-925-3711