Provider Demographics
NPI:1215363718
Name:DERAI HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:DERAI HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDIONWELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-338-4973
Mailing Address - Street 1:646 PROSPERITY WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7029
Mailing Address - Country:US
Mailing Address - Phone:757-312-0434
Mailing Address - Fax:
Practice Address - Street 1:646 PROSPERITY WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7029
Practice Address - Country:US
Practice Address - Phone:757-312-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health