MEDICARE: JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	011608	OTHER	VA	ANTHEM BLUE CROSS BLUE SH

General Provider Information

NPI Number	:	1790791176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED

Provider Business Mailing Address
First Line	:	5000 CORPORATE WOODS DR
Second Line	:	SUITE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-321-2244
Fax Number	:	757-321-2260

Provider Business Practice Location Address
First Line	:	5000 CORPORATE WOODS DR
Second Line	:	SUITE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-321-2244
Fax Number	:	757-321-2260

Authorized Official
Title or Position	:	CFO
Name	:	LISA DENISE BENJAMIN
Credential	:	CPA
Telephone Number	:	757-321-2247

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/29/2021

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Directions to “JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED ” Practice Location

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