Provider Demographics
NPI:1760781447
Name:SHAVONTE'S PERSONAL TOUCH NURSING SERVICES LLC
Entity Type:Organization
Organization Name:SHAVONTE'S PERSONAL TOUCH NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONTE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:CHESTNUT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:804-833-4655
Mailing Address - Street 1:3303 E BROAD ROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224
Mailing Address - Country:US
Mailing Address - Phone:804-833-4655
Mailing Address - Fax:
Practice Address - Street 1:3303 E BROAD ROCK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-3503
Practice Address - Country:US
Practice Address - Phone:804-833-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002075539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty