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General NPI Number Information
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NPI Number | 1396067096
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Entity Type | Organization
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Legal Business Name | CDA HOMECARE INC
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 208 LEWIS RD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-1326
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Country | US
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Telephone | 757-570-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 208 LEWIS RD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-1326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HARRELL J PITTMAN JR.
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Credential |
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Telephone | 757-570-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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