Provider Demographics
NPI:1568022382
Name:MED PRO HOME HEALTH AND STAFFING LLC
Entity Type:Organization
Organization Name:MED PRO HOME HEALTH AND STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-541-7199
Mailing Address - Street 1:5601 VIRGINIA BEACH BLVD STE 102A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5630
Mailing Address - Country:US
Mailing Address - Phone:757-541-7199
Mailing Address - Fax:
Practice Address - Street 1:5601 VIRGINIA BEACH BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5630
Practice Address - Country:US
Practice Address - Phone:757-541-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care