Provider Demographics
NPI:1598451056
Name:ST RAPHEAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:ST RAPHEAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-773-5313
Mailing Address - Street 1:909 WALNUT NECK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0664
Mailing Address - Country:US
Mailing Address - Phone:757-773-5313
Mailing Address - Fax:
Practice Address - Street 1:909 WALNUT NECK CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0664
Practice Address - Country:US
Practice Address - Phone:757-773-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty