Provider Demographics
NPI:1194028803
Name:SENTARA ENTERPRISES
Entity Type:Organization
Organization Name:SENTARA ENTERPRISES
Other - Org Name:SENTARA HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARD
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 1:871 MARTIN LUTHER KING JR WAY STE 201
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3277
Practice Address - Country:US
Practice Address - Phone:540-564-5735
Practice Address - Fax:540-433-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004972562Medicaid
VA497256BMedicare Oscar/Certification