Provider Demographics
NPI:1922288737
Name:ST MARYS HOME CARE SERVICES OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:ST MARYS HOME CARE SERVICES OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-363-1462
Mailing Address - Street 1:707 LONDON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2412
Mailing Address - Country:US
Mailing Address - Phone:757-399-0848
Mailing Address - Fax:757-399-0849
Practice Address - Street 1:707 LONDON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2412
Practice Address - Country:US
Practice Address - Phone:757-399-0848
Practice Address - Fax:757-399-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-08448251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health