A Family Is Eternal

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

A FAMILY IS ETERNAL

Practice address

1889 S Sycamore St
Petersburg, VA 23805-2730

Phone

(804) 605-9845

Fax

(804) 895-7853

NPI assigned

Dec 27, 2022

Organization subpart

No

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

Authorized official

Name

Nita Viann Randolph DavisonNPI 1174934921

Title

Manager

Phone

(804) 552-1397

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nita Viann Randolph Davison

  • Community Health Worker
  • Petersburg, VA
  • NPI 1174934921
  NPD Authorized official

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

{
    "created_epoch": "1672099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672099200000",
    "number": "1699488494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1889 S SYCAMORE ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052730",
            "telephone_number": "804-605-9845",
            "fax_number": "804-895-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1889 S SYCAMORE ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052730",
            "telephone_number": "804-605-9845",
            "fax_number": "804-895-7853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A FAMILY IS ETERNAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-27",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "DAVISON",
        "authorized_official_first_name": "NITA",
        "authorized_official_middle_name": "VIANN RANDOLPH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "804-552-1397"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Petersburg, VA
• Exclusive Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; 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.