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General NPI Number Information
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NPI Number | 1780217604
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Entity Type | Organization
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Legal Business Name | MYB ENTERPRISES
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 200 HIGH ST STE 201
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3721
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Country | US
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Telephone | 757-822-3835
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Fax | 757-822-3835
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Provider Business Mailing Address
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Address Line | 200 HIGH ST STE 201
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3721
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Country | US
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Telephone | 757-822-3835
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Fax | 757-822-3835
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KRISTAL BROOKS
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Credential |
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Telephone | 757-822-3835
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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