=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215109756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAPPHIRE HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 S SYCAMORE ST SUITE 2
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-862-2583
-----------------------------------------------------
Fax | 804-862-2536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 S SYCAMORE ST SUITE 2
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-862-2583
-----------------------------------------------------
Fax | 804-862-2536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. SHERILYN MERRITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-862-2583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-08479
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------