Provider Demographics
NPI:1497935753
Name:TEAM NURSE, INC.
Entity Type:Organization
Organization Name:TEAM NURSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-575-5200
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:330 MAIN STREET
Mailing Address - City:BROOKNEAL
Mailing Address - State:VA
Mailing Address - Zip Code:24528-0015
Mailing Address - Country:US
Mailing Address - Phone:434-376-8240
Mailing Address - Fax:434-376-8260
Practice Address - Street 1:330 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BROOKNEAL
Practice Address - State:VA
Practice Address - Zip Code:24528
Practice Address - Country:US
Practice Address - Phone:434-376-8240
Practice Address - Fax:434-376-8260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC2100X, 251B00000X, 3747P1801X, 385H00000X
VAHCO-10449251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0152717952Medicaid
VA1497935753OtherPRIVATE DUTY MEDICAID
VA0152716988Medicaid
VAHCO-09449OtherSTATE LICENSURE