Provider Demographics
NPI:1831754324
Name:CONVENIENT HEALTHCARE VA, LLC
Entity type:Organization
Organization Name:CONVENIENT HEALTHCARE VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:757-504-3211
Mailing Address - Street 1:2208 EXECUTIVE DR STE D
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6603
Mailing Address - Country:US
Mailing Address - Phone:757-964-9111
Mailing Address - Fax:757-751-0774
Practice Address - Street 1:2208 EXECUTIVE DR STE D
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6603
Practice Address - Country:US
Practice Address - Phone:757-964-9111
Practice Address - Fax:757-751-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134676117Medicaid