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General NPI Number Information
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NPI Number | 1578935607
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Entity Type | Organization
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Legal Business Name | C & R DIVINE HANDS OF CARE
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 3741 HISTORYLAND DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3307
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Country | US
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Telephone | 757-201-0229
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Fax | 757-648-1207
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Provider Business Mailing Address
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Address Line | 3741 HISTORYLAND DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3307
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Country | US
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Telephone | 757-201-0229
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Fax | 757-648-1207
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Authorized Official
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Title or Position | SERVICE FACILITATOR
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Name | MRS. CAROLYN D JORDAN
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Credential |
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Telephone | 757-201-0229
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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 | 0443787070
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License Number State | VA
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