Healthcare Provider Details

I. General information

NPI: 1467913822
Provider Name (Legal Business Name): PHENOMENAL HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S PARLIAMENT DR STE 201
VIRGINIA BEACH VA
23462-6311
US

IV. Provider business mailing address

405 S PARLIAMENT DR STE 201
VIRGINIA BEACH VA
23462-6311
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-2357
  • Fax:
Mailing address:
  • Phone: 757-937-2357
  • Fax:

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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. INGRID DARLETTE FRASER
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-937-2357