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NPI Code Detail

MEDICARE: HOMEHAVENVILLAGELLC

MEDICARE: HOMEHAVENVILLAGELLC
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
1251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1942169388
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOMEHAVENVILLAGELLC
Provider Business Mailing Address
First Line : 3549 TYRE NECK RD
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-3321
Country : US
Telephone Number : 757-615-7921
Fax Number :
Provider Business Practice Location Address
First Line : 3549 TYRE NECK RD
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-3321
Country : US
Telephone Number : 757-615-7921
Fax Number :
Authorized Official
Title or Position : OWNER
Name : IMANI WHITESIDE
Credential :
Telephone Number : 757-615-7921
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Directions to “HOMEHAVENVILLAGELLC ” Practice Location

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