Provider Demographics
NPI:1639643398
Name:DOREEN HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DOREEN HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-627-6600
Mailing Address - Street 1:1216 GRANBY ST STE 18
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2622
Mailing Address - Country:US
Mailing Address - Phone:757-627-6600
Mailing Address - Fax:757-383-6115
Practice Address - Street 1:1216 GRANBY ST STE 18
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2622
Practice Address - Country:US
Practice Address - Phone:757-627-6600
Practice Address - Fax:757-383-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497133870Medicaid