Healthcare Provider Details

I. General information

NPI: 1336036086
Provider Name (Legal Business Name): MARIA-GORRETTI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4852 BOXFORD RD
VIRGINIA BEACH VA
23456-5010
US

IV. Provider business mailing address

4852 BOXFORD RD
VIRGINIA BEACH VA
23456-5010
US

V. Phone/Fax

Practice location:
  • Phone: 757-749-7595
  • Fax:
Mailing address:
  • Phone: 757-749-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY ABUTU OBEYA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-749-7595