Healthcare Provider Details

I. General information

NPI: 1518912377
Provider Name (Legal Business Name): NINE PALMS 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 DISCOVERY PARK BLVD STE 200
WILLIAMSBURG VA
23188-2860
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-2536
  • Fax: 757-253-8068
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GINN
Title or Position: CFO
Credential:
Phone: 225-299-3726