MEDICARE: CHANTA HILL

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	253Z00000X	In Home Supportive Care Agency	253Z00000X	VA

General Provider Information

NPI Number	:	1073376760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTA HILL

Provider Business Mailing Address
First Line	:	509 GLADSTONE RD APT B
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-3659
Country	:	US
Telephone Number	:	757-319-3447
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 GLADSTONE RD APT B
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-3659
Country	:	US
Telephone Number	:	757-319-3447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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Directions to “ CHANTA HILL ” Practice Location

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