Healthcare Provider Details

I. General information

NPI: 1558162479
Provider Name (Legal Business Name): TBOMB HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2697 INTERNATIONAL PKWY
VAB VA
23452-7803
US

IV. Provider business mailing address

2697 INTERNATIONAL PKWY PARKWAY ONE SUITE103
VIRGINIA BEACH VA
23452-7803
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-3697
  • Fax:
Mailing address:
  • Phone: 757-773-3697
  • Fax: 757-280-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WYNN
Title or Position: OWNER
Credential:
Phone: 757-773-3697