Provider Demographics
NPI:1750730628
Name:PODIATRY HOME CARE LLC
Entity type:Organization
Organization Name:PODIATRY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:100-000-0000
Mailing Address - Street 1:7750 OGDEN AVE
Mailing Address - Street 2:APT A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2069
Mailing Address - Country:US
Mailing Address - Phone:100-000-0000
Mailing Address - Fax:757-965-4765
Practice Address - Street 1:1567 ASPIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1532
Practice Address - Country:US
Practice Address - Phone:757-965-4765
Practice Address - Fax:757-965-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000695213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty