Provider Demographics
NPI:1497133870
Name:DOREEN HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DOREEN HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-627-6600
Mailing Address - Street 1:1216 GRANBY ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2607
Mailing Address - Country:US
Mailing Address - Phone:757-627-6600
Mailing Address - Fax:757-627-6604
Practice Address - Street 1:1216 GRANBY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2607
Practice Address - Country:US
Practice Address - Phone:757-627-6600
Practice Address - Fax:757-627-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA917368251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid