Provider Demographics
NPI:1467913822
Name:PHENOMENAL HOME CARE SERVICES
Entity Type:Organization
Organization Name:PHENOMENAL HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:DARLETTE
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-937-2357
Mailing Address - Street 1:405 S PARLIAMENT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6311
Mailing Address - Country:US
Mailing Address - Phone:757-937-2357
Mailing Address - Fax:
Practice Address - Street 1:405 S PARLIAMENT DR STE 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6311
Practice Address - Country:US
Practice Address - Phone:757-937-2357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)