Provider Demographics
NPI:1972266203
Name:NURSE NICOLE'S HOME CARE, LLC
Entity Type:Organization
Organization Name:NURSE NICOLE'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:804-731-4590
Mailing Address - Street 1:2545 BELLWOOD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-4481
Mailing Address - Country:US
Mailing Address - Phone:804-731-4590
Mailing Address - Fax:
Practice Address - Street 1:2545 BELLWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-4481
Practice Address - Country:US
Practice Address - Phone:804-731-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health