MEDICARE: NINE PALMS 1, 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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	236402	OTHER	VA	MAMSI
2	299072	OTHER	VA	MAMSI HEALTH PLANS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5965078	OTHER	VA	AETNA US HEALTH CARE
5	19649	OTHER	VA	SENTARA HEALTH PLAN
6	004971248	OTHER	VA	VA PRIEIMER HEALTH PLAN
7	226349	OTHER	VA	MAMSI HEALTH PLANS
8	442171	OTHER	VA	BCBS VA ANTHEM
9	004971159	OTHER	VA	VA PRIEIMER HEALTH PLAN
10	442235	OTHER	VA	BCBS VA ANTHEM
11	442173	OTHER	VI	BCBS VA ANTHEM
12	442175	OTHER	VA	BCBS VA ANTHEM
13	1851340	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1518912377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NINE PALMS 1, LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4897
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	5360 DISCOVERY PARK BLVD STE 200
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2860
Country	:	US
Telephone Number	:	757-253-2536
Fax Number	:	757-253-8068

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	JOSHUA L. PROFFITT
Credential	:
Telephone Number	:	617-639-4092

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/20/2026

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