Provider Demographics
NPI:1114435161
Name:MOMENTUM HOME CARE HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:MOMENTUM HOME CARE HEALTH NETWORK LLC
Other - Org Name:MOMENTUM HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-828-4054
Mailing Address - Street 1:742 THIMBLE SHOALS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3561
Mailing Address - Country:US
Mailing Address - Phone:757-828-4054
Mailing Address - Fax:757-828-3667
Practice Address - Street 1:742 THIMBLE SHOALS BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3561
Practice Address - Country:US
Practice Address - Phone:757-828-4054
Practice Address - Fax:757-828-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health