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General NPI Number Information
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NPI Number | 1568241891
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Entity Type | Individual
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Provider Name | EPHESUS BROOKS
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Gender | Male
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2801 PENNINGTON RD
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City | HENRICO
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State | VA
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Zip | 23294-4013
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Country | US
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Telephone | 804-418-7999
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3262
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Country | US
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Telephone | 804-972-1132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | T67133866
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 226000000X
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Taxonomy Name | Recreational Therapist Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 247000000X
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Taxonomy Name | Health Information Technician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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