MEDICARE: DESIRABLE HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1023602026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESIRABLE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	1328 E PEMBROKE AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-2445
Country	:	US
Telephone Number	:	757-379-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 E PEMBROKE AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-2445
Country	:	US
Telephone Number	:	757-379-1660
Fax Number	:	855-679-9729

Authorized Official
Title or Position	:	OWNER
Name	:	DESIREE OUTLAW
Credential	:	NP
Telephone Number	:	757-379-1660

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	10/30/2023

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