Provider Source Home Health Care

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDER SOURCE HOME HEALTH CARE

Practice address

2211 Pretty Lake Ave Unit 403
Norfolk, VA 23518-1047

Phone

(757) 324-2979

Fax

(757) 257-4575

NPI assigned

Mar 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kena Dickens

Title

Administrator

Phone

(757) 324-2979

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1396330890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 PRETTY LAKE AVE UNIT 403",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235181047",
            "telephone_number": "757-324-2979",
            "fax_number": "757-257-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 PRETTY LAKE AVE UNIT 403",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235181047",
            "telephone_number": "757-324-2979",
            "fax_number": "757-257-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER SOURCE HOME HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "KENA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "757-324-2979"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Norfolk, VA
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• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.