Provider Demographics
NPI:1578935607
Name:C & R DIVINE HANDS OF CARE
Entity Type:Organization
Organization Name:C & R DIVINE HANDS OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE FACILITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-201-0229
Mailing Address - Street 1:3741 HISTORYLAND DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3307
Mailing Address - Country:US
Mailing Address - Phone:757-201-0229
Mailing Address - Fax:757-648-1207
Practice Address - Street 1:3741 HISTORYLAND DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3307
Practice Address - Country:US
Practice Address - Phone:757-201-0229
Practice Address - Fax:757-648-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0443787070251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0178313646OtherAPI