Healthcare Provider Details

I. General information

NPI: 1255125159
Provider Name (Legal Business Name): JP GRAND HEARTS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 GITTINGS ST STE 100L
SUFFOLK VA
23434-6156
US

IV. Provider business mailing address

707 GITTINGS ST STE 100L
SUFFOLK VA
23434-6156
US

V. Phone/Fax

Practice location:
  • Phone: 757-615-7063
  • Fax:
Mailing address:
  • Phone: 757-615-7063
  • Fax:

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: CERIA MIZELL
Title or Position: OWNER
Credential:
Phone: 757-615-7063