Provider Demographics
NPI:1639512262
Name:PATIENT CENTERED CARE
Entity Type:Organization
Organization Name:PATIENT CENTERED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-397-0843
Mailing Address - Street 1:808 LOUDOUN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3234
Mailing Address - Country:US
Mailing Address - Phone:757-397-0843
Mailing Address - Fax:757-397-0849
Practice Address - Street 1:808 LOUDOUN AVE
Practice Address - Street 2:STE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3234
Practice Address - Country:US
Practice Address - Phone:757-397-0843
Practice Address - Fax:757-397-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-13950251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health