Healthcare Provider Details

I. General information

NPI: 1659287456
Provider Name (Legal Business Name): THE HOME OF CATHERINES HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 CONDOR ST
VIRGINIA BEACH VA
23462-1852
US

IV. Provider business mailing address

5205 CONDOR ST
VIRGINIA BEACH VA
23462-1852
US

V. Phone/Fax

Practice location:
  • Phone: 757-202-3099
  • Fax:
Mailing address:
  • Phone: 757-202-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LATRINA ANGEL MATHEWS
Title or Position: OWNER
Credential:
Phone: 757-202-3099