Provider Demographics
NPI:1114097532
Name:SENTARA ENTERPRISES
Entity Type:Organization
Organization Name:SENTARA ENTERPRISES
Other - Org Name:SENTARA HOME CARE SERVICES - NEWPORT NEWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, SENTARA ENTERPRISES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GADEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-553-3000
Mailing Address - Street 1:535 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5176
Mailing Address - Country:US
Mailing Address - Phone:757-553-3000
Mailing Address - Fax:757-382-4957
Practice Address - Street 1:535 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5176
Practice Address - Country:US
Practice Address - Phone:757-553-3000
Practice Address - Fax:757-382-4957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA045615251G00000X
VA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004910109Medicaid
337460OtherANTHEM HOSPICE
337460OtherANTHEM HOSPICE