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General NPI Number Information
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NPI Number | 1831605740
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Entity Type | Organization
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Legal Business Name | AMETHYST LILY PERSONAL CARE SERVICES, LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 502E FOREST OAK LN
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City | SUFFOLK
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State | VA
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Zip | 23434-5464
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Country | US
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Telephone | 757-324-0614
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Fax | 757-539-4788
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Provider Business Mailing Address
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Address Line | 502E FOREST OAK LN
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City | SUFFOLK
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State | VA
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Zip | 23434-5464
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Country | US
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Telephone | 757-324-0614
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Fax | 757-539-4788
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | RHONDA NFEWSOM
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Credential | RN
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Telephone | 757-324-0614
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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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