=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275784191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL TOUCH HOME CARE OF VA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2008
-----------------------------------------------------
Last Update Date | 10/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21204 NORTH BAYSIDE ROAD
-----------------------------------------------------
City | CHERITON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-331-1327
-----------------------------------------------------
Fax | 757-331-2317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22215 NORTHERN BLVD 3RD FLOOR
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-468-4747
-----------------------------------------------------
Fax | 718-264-5834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACT MANAGER
-----------------------------------------------------
Name | LORIGAY LASKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-468-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------