Healthcare Provider Details

I. General information

NPI: 1356656649
Provider Name (Legal Business Name): MESSIAH HEAVENLY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SHORE DR STE 103
VIRGINIA BEACH VA
23455-2893
US

IV. Provider business mailing address

4701 SHORE DR STE 103
VIRGINIA BEACH VA
23455-2893
US

V. Phone/Fax

Practice location:
  • Phone: 757-545-6196
  • Fax: 866-554-3602
Mailing address:
  • Phone: 757-545-6196
  • Fax: 866-554-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: VALERIE ABBOTT
Title or Position: AGENT
Credential:
Phone: 757-718-3964