Healthcare Provider Details

I. General information

NPI: 1376948935
Provider Name (Legal Business Name): T.S. DATA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE COLUMBUS CENTER STE #26
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

1425 BATTLEFIELD BLVD BOX #3112
CHESAPEAKE VA
23327-3112
US

V. Phone/Fax

Practice location:
  • Phone: 757-416-5001
  • Fax: 877-839-8853
Mailing address:
  • Phone: 757-416-5001
  • Fax: 877-839-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number017
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number017
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number2014257663-R
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number2014257663-R
License Number StateVA

VIII. Authorized Official

Name: TREMYLE ROGERS
Title or Position: CARE COORDINATOR
Credential:
Phone: 757-393-1519