MEDICARE: MED PRO HOME HEALTH AND STAFFING 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	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568022382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED PRO HOME HEALTH AND STAFFING LLC

Provider Business Mailing Address
First Line	:	5601 VIRGINIA BEACH BLVD STE 102A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5630
Country	:	US
Telephone Number	:	757-541-7199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 VIRGINIA BEACH BLVD STE 102A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5630
Country	:	US
Telephone Number	:	757-541-7199
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	SHANIQAH MCLEOD
Credential	:	RN
Telephone Number	:	757-541-7199

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/14/2019

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