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General NPI Number Information
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NPI Number | 1801180443
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PARENT CARE LLC
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 317 N ROSEMONT RD SUITE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3449
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Country | US
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Telephone | 757-323-2865
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Fax | 757-962-4855
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Provider Business Mailing Address
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Address Line | 317 N ROSEMONT RD SUITE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3449
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Country | US
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Telephone | 757-323-2865
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Fax | 757-962-4855
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. KEITH RYDELL OWENS
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Credential |
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Telephone | 757-778-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | S352074-1
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License Number State | VA
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