Healthcare Provider Details

I. General information

NPI: 1255871877
Provider Name (Legal Business Name): BEACON OF HOPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 SALEM RD # 7
VIRGINIA BEACH VA
23456-1308
US

IV. Provider business mailing address

3600 BRANNON DR
VIRGINIA BEACH VA
23456-6908
US

V. Phone/Fax

Practice location:
  • Phone: 757-404-6078
  • Fax:
Mailing address:
  • Phone: 757-404-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: MARSHA KENTISH
Title or Position: PRESIDENT
Credential: RN
Phone: 757-404-6078