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NPI Code Detail

MEDICARE: HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC.

MEDICARE: HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC.
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
1261QC1500XCommunity Health Clinic/Center0024166077VA

General Provider Information

NPI Number : 1245478221
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC.
Provider Business Mailing Address
First Line : 132 MAPLE AVE
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23607-5542
Country : US
Telephone Number : 757-245-0529
Fax Number :
Provider Business Practice Location Address
First Line : 1320 LASALLE AVE
Second Line :
City : HAMPTON
State : VA
Zip : 23669-3801
Country : US
Telephone Number : 757-727-2577
Fax Number : 757-723-0469
Authorized Official
Title or Position : CLIENT SERVICES COORDINATOR
Name : CHERYL MARIE ROBIDA
Credential :
Telephone Number : 757-727-2577
Provider Enumeration Date : 01/28/2009
Last Update Date : 05/29/2019

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Directions to “HAMPTON ROADS ECUMENICAL LODGINGS AND PROVISIONS, INC. ” Practice Location

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