MEDICARE: OUR EXTENDED FAMILY 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558298141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR EXTENDED FAMILY LLC

Provider Business Mailing Address
First Line	:	6212 GENEVA WAY APT B
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-1550
Country	:	US
Telephone Number	:	757-714-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	7404 OAKMONT DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-1012
Country	:	US
Telephone Number	:	757-714-2255
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PATRICIA MONIQUE EDWARDS
Credential	:
Telephone Number	:	757-714-2255

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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