Healthcare Provider Details

I. General information

NPI: 1962235226
Provider Name (Legal Business Name): REGINA'S HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 FIRST COLONIAL RD STE 204G
VIRGINIA BEACH VA
23454-3198
US

IV. Provider business mailing address

3110 CHALFIN AVENUE A
NORFOLK VA
23513
US

V. Phone/Fax

Practice location:
  • Phone: 757-359-4508
  • Fax:
Mailing address:
  • Phone: 757-359-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESA FAUNTLEROY
Title or Position: OWNER
Credential:
Phone: 757-359-4508