Provider Demographics
NPI:1255419164
Name:TEAM NURSE, INC.
Entity type:Organization
Organization Name:TEAM NURSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-323-9464
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0776
Mailing Address - Country:US
Mailing Address - Phone:434-575-5200
Mailing Address - Fax:434-575-5204
Practice Address - Street 1:1372 W GRETNA RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-2472
Practice Address - Country:US
Practice Address - Phone:434-656-6000
Practice Address - Fax:434-656-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC2100X, 251B00000X, 385H00000X, 3747P1801X
VAHCO-10205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255419164OtherPRIVATE DUTY
VA008751072OtherMEDICAID PRIVATE DUTY NURSING
VA0087735723Medicaid
VAHCO-09205OtherSTATE LICENSURE
VA0087046436Medicaid