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General NPI Number Information
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NPI Number | 1861883860
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Entity Type | Organization
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Legal Business Name | D-VINE GRACE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 114 CHOWAN DR SUITE A
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2452
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Country | US
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Telephone | 757-488-1102
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Fax | 757-488-1107
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Provider Business Mailing Address
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Address Line | 114 CHOWAN DR SUITE A
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2452
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Country | US
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Telephone | 757-488-1102
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Fax | 757-488-1107
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Authorized Official
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Title or Position | CEO/OWNER
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Name | NICKY CHARLES
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Credential |
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Telephone | 757-673-4476
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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 | 41999
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 151264
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-171264
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License Number State | VA
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