Fort Norfolk Retirement Community

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

FORT NORFOLK RETIREMENT COMMUNITY

Doing business as

Harbor's Edge Wellness Clinic

Practice address

1 Colley Avenue
Norfolk, VA 23510-1038

Phone

(757) 616-7921

Fax

(757) 616-7955

NPI assigned

Sep 16, 2022

Last updated

Sep 16, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Hisham Fahim

Title

Vice President of Finance/Controlle

Phone

(757) 616-7952

Specialties & licenses 2

Addresses

Other names 1

• Harbor's Edge Wellness Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1982326823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 COLLEY AVENUE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101038",
            "telephone_number": "757-616-7921",
            "fax_number": "757-616-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLLEY AVENUE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235101038",
            "telephone_number": "757-616-7921",
            "fax_number": "757-616-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT NORFOLK RETIREMENT COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-16",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "FAHIM",
        "authorized_official_first_name": "HISHAM",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE/CONTROLLE",
        "authorized_official_telephone_number": "757-616-7952",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor's Edge Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fort Norfolk Plaza Medical Associates, LLC (Fort Norfolk Plaza Primary Care, PC)
• Fort Norfolk Plaza Medical Associates, LLC (Fort Norfolk Plaza Urgent Care)
• Fort Norfolk Plaza Medical Associates, LLC (Fort Norfolk Plaza Cardiology Associates, Inc.)
• Fort Norfolk Plaza Medical Associates, LLC
• Fort Norfolk Plaza Urgent Care (Fort Norfolk Plaza Medical Associates, PLLC)
• Fort Norfolk Retirement Community, Inc. (Harbor's Edge)
• Fort Worth Healthcare
• Bill Jeffrey Forte, M.D.
• Grayson Tyler Fortin, DO
• Jennifer Jane Foss, NP

• Family Nurse Practitioner in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.