Healthcare Provider Details

I. General information

NPI: 1568022382
Provider Name (Legal Business Name): MED PRO HOME HEALTH AND STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 VIRGINIA BEACH BLVD STE 102A
VIRGINIA BEACH VA
23462-5630
US

IV. Provider business mailing address

5601 VIRGINIA BEACH BLVD STE 102A
VIRGINIA BEACH VA
23462-5630
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-7199
  • Fax:
Mailing address:
  • Phone: 757-541-7199
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANIQAH MCLEOD
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 757-541-7199