MEDICARE: ABC SUPPORTIVE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033901350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC SUPPORTIVE LLC

Provider Business Mailing Address
First Line	:	1499 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2827
Country	:	US
Telephone Number	:	757-679-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2827
Country	:	US
Telephone Number	:	757-343-1683
Fax Number	:	757-512-6251

Authorized Official
Title or Position	:	CEO
Name	:	CHARLENE WIMBISH
Credential	:	ADMINTRATOR
Telephone Number	:	757-679-0654

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	12/19/2025

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Directions to “ABC SUPPORTIVE LLC ” Practice Location

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