Healthcare Provider Details

I. General information

NPI: 1811621733
Provider Name (Legal Business Name): M & D HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S PARLIAMENT DR STE 207
VIRGINIA BEACH VA
23462-6301
US

IV. Provider business mailing address

404 S PARLIAMENT DR STE 207
VIRGINIA BEACH VA
23462-6301
US

V. Phone/Fax

Practice location:
  • Phone: 757-777-0032
  • Fax: 757-301-5251
Mailing address:
  • Phone: 757-777-0032
  • Fax: 757-301-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DYSHELL GARDNER
Title or Position: OWNER
Credential:
Phone: 757-777-0032