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General NPI Number Information
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NPI Number | 1740601079
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Entity Type | Organization
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Legal Business Name | TABB HEALTHCARE, LLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 3029 KNIGHT RD
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City | CHESAPEAKE
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State | VA
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Zip | 23323-2828
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Country | US
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Telephone | 757-513-9195
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 ERIC CT
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City | CHESAPEAKE
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State | VA
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Zip | 23323-2744
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Country | US
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Telephone | 757-513-9195
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. JAMIE MELISSA TABB
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Credential | RN, BS
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Telephone | 757-513-9195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 2057
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License Number State | VA
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