Provider Demographics
NPI:1376210252
Name:HEALING ABODE HEALTHCARE AGENCY, LLC
Entity type:Organization
Organization Name:HEALING ABODE HEALTHCARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:KENYELL
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-937-9311
Mailing Address - Street 1:464 INVESTORS PL STE 204J
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1167
Mailing Address - Country:US
Mailing Address - Phone:317-941-1460
Mailing Address - Fax:
Practice Address - Street 1:464 INVESTORS PL STE 204J
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1167
Practice Address - Country:US
Practice Address - Phone:317-941-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty