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General NPI Number Information
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NPI Number | 1619687720
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Entity Type | Organization
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Legal Business Name | INTENSACARE HOME HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 437 BEAUREGARD AVE
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City | PETERSBURG
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State | VA
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Zip | 23805-2017
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Country | US
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Telephone | 804-372-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 CARMIA WAY # 1039
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4750
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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 | NURSING DIRECTOR
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Name | CHANTA HARRIS
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Credential | RN
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Telephone | 804-616-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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