Provider Demographics
NPI:1629469523
Name:SENORA ANGELS HOME HEALTH AND SERVICES
Entity Type:Organization
Organization Name:SENORA ANGELS HOME HEALTH AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QEUNNA
Authorized Official - Middle Name:DONTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-214-6922
Mailing Address - Street 1:860 GREENBRIER CIR STE 212
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2640
Mailing Address - Country:US
Mailing Address - Phone:577-367-8367
Mailing Address - Fax:757-226-9173
Practice Address - Street 1:860 GREENBRIER CIR STE 212
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:577-367-8367
Practice Address - Fax:757-226-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-181553Medicaid