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General NPI Number Information
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NPI Number | 1669788626
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL HEALTHCARE ASSOCIATES
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 1419 SIERRA DR
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City | SUFFOLK
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State | VA
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Zip | 23434-2847
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Country | US
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Telephone | 757-506-4538
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 SIERRA DR
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City | SUFFOLK
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State | VA
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Zip | 23434-2847
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Country | US
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Telephone | 757-506-4538
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. WANDA RENNE RIDDICK
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Credential | NURSE
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Telephone | 757-506-4538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 00-0000000
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 00-0000000
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 00-0000000
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License Number State | VA
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