Immaculate Care Services LLC.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

IMMACULATE CARE SERVICES LLC.

Practice address

5935 Knightsbridge Way
Portsmouth, VA 23703-5506

Phone

(757) 335-2404

NPI assigned

Sep 19, 2018

Organization subpart

No

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

Authorized official

Name

Minnie R Savage

Title

Owner

Phone

(757) 335-2404

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1972087666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5935 KNIGHTSBRIDGE WAY",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237035506",
            "telephone_number": "757-335-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5935 KNIGHTSBRIDGE WAY",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237035506",
            "telephone_number": "757-335-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE CARE SERVICES LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "SAVAGE",
        "authorized_official_first_name": "MINNIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-335-2404"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A24698259",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Exclusive Provider Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.