Provider Demographics
NPI:1790137602
Name:GREATER HEIGHTS HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:GREATER HEIGHTS HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/VICE PRESICENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-388-6976
Mailing Address - Street 1:5348 SUMMER CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1948
Mailing Address - Country:US
Mailing Address - Phone:910-388-6976
Mailing Address - Fax:
Practice Address - Street 1:5348 SUMMER CRES
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1948
Practice Address - Country:US
Practice Address - Phone:910-388-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care