Healthcare Provider Details

I. General information

NPI: 1750829164
Provider Name (Legal Business Name): SENTARA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
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

535 INDEPENDENCE PKWY SUITE 200
CHESAPEAKE VA
23320-5176
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-1350
  • Fax: 757-837-4711
Mailing address:
  • Phone: 757-553-3000
  • Fax: 757-382-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-171575
License Number StateVA

VIII. Authorized Official

Name: TERESA L EDWARDS
Title or Position: PRESIDENT
Credential:
Phone: 757-553-3000