=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821396680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEED OF FAITH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2011
-----------------------------------------------------
Last Update Date | 03/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 CHRISTA CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-462-0812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 CHRISTA CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-462-0812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BRANDEE TILLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-462-0812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 116130509
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------