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General NPI Number Information
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NPI Number | 1801369715
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Entity Type | Organization
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Legal Business Name | GREENLIGHT HOMECARE SERVICES, LLC
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1206 LASKIN RD STE 140G
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5267
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Country | US
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Telephone | 757-998-0528
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Fax | 757-807-7248
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Provider Business Mailing Address
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Address Line | 1206 LASKIN RD STE 140G
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5267
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Country | US
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Telephone | 757-998-0528
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Fax | 757-807-7248
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KRISTINA MATTHEWS
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Credential | MA, CNA, QMHP
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Telephone | 757-998-0528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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