Healthcare Provider Details

I. General information

NPI: 1306486683
Provider Name (Legal Business Name): BRANDI MERCEDES PRYOR HCO PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERISHED HOME SERVICES LLC HCO PROVIDER

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 HOLLAND RD STE 204
VIRGINIA BEACH VA
23452-4063
US

IV. Provider business mailing address

2412 CREEKMORE CT
VIRGINIA BEACH VA
23464-8843
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-2396
  • Fax: 757-220-2396
Mailing address:
  • Phone: 757-319-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2978-01-001
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberHCO-222657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: