=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447587571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE JASMINE CHARITABLE TRUST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 11/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 782 BELLWOOD RD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-838-7000
-----------------------------------------------------
Fax | 757-827-6913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 782 BELLWOOD RD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-838-7000
-----------------------------------------------------
Fax | 757-827-6913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. BEVERLEE J ENGLE
-----------------------------------------------------
Credential | HSD., PHD.
-----------------------------------------------------
Telephone | 757-838-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------