Healthcare Provider Details

I. General information

NPI: 1053814483
Provider Name (Legal Business Name): IMPERIAL HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 CAMELLIA DR APT A
SUFFOLK VA
23435-2298
US

IV. Provider business mailing address

6040 CAMELLIA DR APT A
SUFFOLK VA
23435-2298
US

V. Phone/Fax

Practice location:
  • Phone: 202-578-4720
  • Fax: 757-257-5993
Mailing address:
  • Phone: 202-578-4720
  • Fax: 757-257-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RYNESHA KNIGHT
Title or Position: CEO
Credential:
Phone: 202-578-4720