Healthcare Provider Details

I. General information

NPI: 1962220541
Provider Name (Legal Business Name): PINKSLAYER COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920A BRIDGE RD STE 305
SUFFOLK VA
23435-1126
US

IV. Provider business mailing address

1005 JEFFERSON ST
SUFFOLK VA
23434-4012
US

V. Phone/Fax

Practice location:
  • Phone: 757-240-8127
  • Fax:
Mailing address:
  • Phone: 757-240-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTIE FIELDS
Title or Position: CEO
Credential: MHS
Phone: 757-240-8127