MEDICARE: A BEAUTIFUL MIND, 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	302R00000X	Health Maintenance Organization	2348	VA

General Provider Information

NPI Number	:	1073928487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BEAUTIFUL MIND, LLC.

Provider Business Mailing Address
First Line	:	1600 E LITTLE CREEK RD
Second Line	:	SUITE 315
City	:	NORFOLK
State	:	VA
Zip	:	23518-4136
Country	:	US
Telephone Number	:	757-962-8640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E LITTLE CREEK RD
Second Line	:	SUITE 315
City	:	NORFOLK
State	:	VA
Zip	:	23518-4136
Country	:	US
Telephone Number	:	757-962-8640
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MARLENE NATALEE OROSCO
Credential	:
Telephone Number	:	757-286-6054

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	07/03/2014

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