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General NPI Number Information
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NPI Number | 1265765879
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC HOMECARE
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 2003 KELSEY BAY CT
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City | CHESAPEAKE
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State | VA
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Zip | 23323-5346
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Country | US
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Telephone | 757-376-6882
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Fax | 757-558-3633
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Provider Business Mailing Address
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Address Line | 2003 KELSEY BAY CT
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City | CHESAPEAKE
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State | VA
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Zip | 23323-5346
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Country | US
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Telephone | 757-376-6882
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Fax | 757-558-3633
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Authorized Official
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Title or Position | PRINCIPAL
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Name | LE ROY HALSTEAD
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Credential | RN
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Telephone | 757-376-6882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | VA
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