Healthcare Provider Details

I. General information

NPI: 1710270186
Provider Name (Legal Business Name): HOUSE OF ANGELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 EDWIN DR
VA BEACH VA
23462
US

IV. Provider business mailing address

381 EDWIN DR
VA BEACH VA
23462
US

V. Phone/Fax

Practice location:
  • Phone: 757-322-7369
  • Fax:
Mailing address:
  • Phone: 757-322-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHARIF BENNETT HINES
Title or Position: DIRECTOR
Credential: RN
Phone: 757-322-7369