=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841722600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENESYS HOME HEALTH CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2017
-----------------------------------------------------
Last Update Date | 10/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1613 S CHURCH ST STE 6
-----------------------------------------------------
City | SMITHFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23430-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-356-0566
-----------------------------------------------------
Fax | 757-356-0599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 676 BATTLEFIELD BLVD N STE A
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-420-0566
-----------------------------------------------------
Fax | 757-420-0599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHANTE HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-420-0566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | HCO171051
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | HCO171051
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 385HR2065X
-----------------------------------------------------
Taxonomy Name | Child Physical Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO171051
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------