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General NPI Number Information
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NPI Number | 1083495386
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Entity Type | Organization
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Legal Business Name | GIFTED MINDS RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 4349 INDIAN RIVER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3115
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Country | US
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Telephone | 757-761-8629
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Fax |
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Provider Business Mailing Address
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Address Line | 4349 INDIAN RIVER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23325-3115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QEUNNA SMITH
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Credential | RN
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Telephone | 757-761-8629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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