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General NPI Number Information
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NPI Number | 1497568802
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Entity Type | Organization
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Legal Business Name | ELISHEBA OF MT ZION
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 105 TURRET LN APT 3
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City | HAMPTON
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State | VA
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Zip | 23669-4377
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Country | US
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Telephone | 757-325-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 105 TURRET LN APT 3
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City | HAMPTON
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State | VA
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Zip | 23669-4377
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Country | US
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Telephone | 757-325-7313
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | QETURAH GUNN
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Credential |
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Telephone | 757-325-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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