MEDICARE: PURPLE SERVICE ANNOUNCEMENT

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467341552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE SERVICE ANNOUNCEMENT

Provider Business Mailing Address
First Line	:	2313 RED TIDE RD UNIT 1
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1203
Country	:	US
Telephone Number	:	910-703-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 RED TIDE RD UNIT 2
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23451-1203
Country	:	US
Telephone Number	:	910-703-2848
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TANIKIA WASHINGTON
Credential	:
Telephone Number	:	910-703-2848

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “PURPLE SERVICE ANNOUNCEMENT ” Practice Location

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