=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144861725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALLAWAY COMPANIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2019
-----------------------------------------------------
Last Update Date | 10/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1545 CROSSWAYS BLVD STE 268
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-0205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-756-6406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1545 CROSSWAYS BLVD STE 268
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-0205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O
-----------------------------------------------------
Name | KRISTY CALLAWAY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 757-756-6406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------