Ephraim Cruz

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

29911 Issued in VA

Practice address

8027 Camellia Rd
Norfolk, VA 23518-3416

Phone

(757) 227-1105

Fax

(757) 214-6634

NPI assigned

Aug 10, 2020

Last updated

Aug 10, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Camellia House LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Norfolk, VA
  • NPI 1164978656

  Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1811508252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8027 CAMELLIA RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235183416",
            "telephone_number": "757-227-1105",
            "fax_number": "757-214-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8027 CAMELLIA RD",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235183416",
            "telephone_number": "757-227-1105",
            "fax_number": "757-214-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "EPHRAIM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "29911",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81-3347603",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Marie Crownover
• Lester Dean Cruise, RN, ANP-C
• Jason Thomas Crump, PAC
• Allison Crute
• Elise Cruz
• Machel L Cruz
• Crystal Baker LLC (inTouch Home Healthcare)
• Vicentia Cudjoe
• Annette Marie Cudnohufsky
• Sarah Linette Cuffee, RD, CPT

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.