MEDICARE: STM GENTLE TOUCH 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	0002072366	VA

General Provider Information

NPI Number	:	1588827976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STM GENTLE TOUCH LLC

Provider Business Mailing Address
First Line	:	5533 CHANDLER SCOTT CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464
Country	:	US
Telephone Number	:	757-420-2744
Fax Number	:

Provider Business Practice Location Address
First Line	:	5533 CHANDLER SCOTT CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5259
Country	:	US
Telephone Number	:	757-420-2744
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	TAMARA MONIQUE DAVIS
Credential	:	LPN
Telephone Number	:	757-754-6756

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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