Provider Demographics
NPI:1982326823
Name:FORT NORFOLK RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:FORT NORFOLK RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE/CONTROLLE
Authorized Official - Prefix:MR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-616-7952
Mailing Address - Street 1:1 COLLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1038
Mailing Address - Country:US
Mailing Address - Phone:757-616-7921
Mailing Address - Fax:757-616-7955
Practice Address - Street 1:1 COLLEY AVENUE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1038
Practice Address - Country:US
Practice Address - Phone:757-616-7921
Practice Address - Fax:757-616-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center