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General NPI Number Information
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NPI Number | 1972194819
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Entity Type | Organization
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Legal Business Name | PURE LIFE HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 15064 CARROLLTON BLVD STE 24
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City | CARROLLTON
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State | VA
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Zip | 23314-3582
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Country | US
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Telephone | 757-952-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 77 CAPE DOREY DR
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City | HAMPTON
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State | VA
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Zip | 23666-6207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QUAESHA KNIGHT
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Credential |
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Telephone | 757-952-7929
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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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