=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154848729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HLA HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2017
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4425 PORTSMOUTH BLVD. STE. 115
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-673-3200
-----------------------------------------------------
Fax | 757-673-6362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4425 PORTSMOUTH BLVD. STE. 115
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23321-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-673-3200
-----------------------------------------------------
Fax | 757-673-6362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. FELICIA ALMOND WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-673-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------