MEDICARE: CENTRAL VIRGINIA HOME CARE, LLC - COLONIAL HEIGHTS

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	253Z00000X	In Home Supportive Care Agency	HCO-161402	VA

General Provider Information

NPI Number	:	1538528195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VIRGINIA HOME CARE, LLC - COLONIAL HEIGHTS

Provider Business Mailing Address
First Line	:	PO BOX 66884
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23466-6884
Country	:	US
Telephone Number	:	877-444-4112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 BOULEVARD
Second Line	:	SUITE B
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1338
Country	:	US
Telephone Number	:	877-444-4112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS J KNOX JR.
Credential	:
Telephone Number	:	757-679-2805

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	11/01/2018

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