Provider Demographics
NPI:1093262487
Name:TEAM NURSE II, INC.
Entity Type:Organization
Organization Name:TEAM NURSE II, INC.
Other - Org Name:TEAM NURSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-575-5200
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:606 BROAD STREET
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0776
Mailing Address - Country:US
Mailing Address - Phone:434-575-5200
Mailing Address - Fax:434-575-5054
Practice Address - Street 1:1372 W GRETNA RD STE B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-2472
Practice Address - Country:US
Practice Address - Phone:434-656-6000
Practice Address - Fax:434-656-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49D2142019OtherCLIA CLINICAL LABORATORY IMPROVEMENT ADMENMENTS CMS
VAHCO0205OtherOLC VIRGINIA DEPT OF HEALTH
VA497757OtherCCN/PTAN MEDICARE #
VA65092OtherACHC