Provider Demographics
NPI:1649568270
Name:DEVOTED PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:DEVOTED PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-383-5470
Mailing Address - Street 1:405 S PARLIAMENT DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 S PARLIAMENT DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6311
Practice Address - Country:US
Practice Address - Phone:757-383-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health