Healthcare Provider Details

I. General information

NPI: 1700138708
Provider Name (Legal Business Name): STANLEYS PERSONAL TOUCH HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WEST WASHINGTON STREET
SUFFOLK VA
23434-6252
US

IV. Provider business mailing address

908 WEST WASHINGTON STREET
SUFFOLK VA
23434-6252
US

V. Phone/Fax

Practice location:
  • Phone: 757-925-1180
  • Fax: 757-925-1190
Mailing address:
  • Phone: 757-925-1180
  • Fax: 757-925-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-13772
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-13772
License Number StateVA

VIII. Authorized Official

Name: MRS. BETTY DIANE RUFFIN
Title or Position: OWNER
Credential:
Phone: 757-925-1180