MEDICARE: ROWE GROUP CONSTRUCTION, 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	171WH0202X	Home Modifications Contractor	2705 128238A	VA

General Provider Information

NPI Number	:	1376840322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROWE GROUP CONSTRUCTION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 5099
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23471-0099
Country	:	US
Telephone Number	:	757-288-6251
Fax Number	:	757-464-1770

Provider Business Practice Location Address
First Line	:	3726 JEFFERSON BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1638
Country	:	US
Telephone Number	:	757-288-6251
Fax Number	:	757-464-1770

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHIRLEY ROWE BLOUNT
Credential	:
Telephone Number	:	757-288-6251

Provider Enumeration Date	:	02/26/2011
Last Update Date	:	02/26/2011

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