Healthcare Provider Details

I. General information

NPI: 1063957199
Provider Name (Legal Business Name): ANGELIC TOUCH CONCIERGE NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BUSINESS PARK DR STE 202
VIRGINIA BEACH VA
23462-6527
US

IV. Provider business mailing address

144 BUSINESS PARK DR STE 202
VIRGINIA BEACH VA
23462-6527
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-9569
  • Fax: 757-937-9570
Mailing address:
  • Phone: 757-937-9569
  • Fax: 757-937-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEMETRIA S CLEMONS
Title or Position: OWNER, ADMINISTRATOR
Credential: RN
Phone: 757-937-9569