=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871043117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAA 24 HOUR HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2016
-----------------------------------------------------
Last Update Date | 10/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 S ROSEMONT RD STE E
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-717-8681
-----------------------------------------------------
Fax | 757-631-4478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 S ROSEMONT RD STE E
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-717-8681
-----------------------------------------------------
Fax | 757-631-4478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASST ADMINISTRATOR
-----------------------------------------------------
Name | ALYIAH PETERKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-717-8681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-171517
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------