Provider Demographics
NPI:1790309540
Name:SHADES OF LIFE HOME CARE SERVICES,LLC
Entity Type:Organization
Organization Name:SHADES OF LIFE HOME CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:CHOLE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:757-672-3507
Mailing Address - Street 1:2201 BAGELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6897
Mailing Address - Country:US
Mailing Address - Phone:757-672-3507
Mailing Address - Fax:757-210-9481
Practice Address - Street 1:138 S ROSEMONT RD STE 211
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4336
Practice Address - Country:US
Practice Address - Phone:757-672-3507
Practice Address - Fax:757-210-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health