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General NPI Number Information
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NPI Number | 1356747588
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE AREA AGENCY ON AGING/COMMUNITY ACTION AGENCY
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 5432 BAYSIDE RD
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City | EXMORE
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State | VA
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Zip | 23350-3936
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Country | US
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Telephone | 757-442-9652
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Fax | 757-442-9303
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Provider Business Mailing Address
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Address Line | 5432 BAYSIDE RD
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City | EXMORE
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State | VA
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Zip | 23350-3936
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Country | US
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Telephone | 757-442-9652
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Fax | 757-442-9303
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Authorized Official
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Title or Position | CEO
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Name | MS. DIANE MUSSO
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Credential |
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Telephone | 757-442-9652
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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 | HCO-15709
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License Number State | VA
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