# ABC SUPPORTIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033901350
- **Authorized official:** CHARLENE WIMBISH ADMINTRATOR (CEO)
- **Authorized official phone:** (757) 679-0654

## Contact information

- **Practice address:** 1499 TIDEWATER DR, NORFOLK, VA 23504-2827
- **Practice address phone:** (757) 343-1683
- **Practice address fax:** (757) 512-6251
- **Mailing address:** 1499 TIDEWATER DR, NORFOLK, VA 23504-2827
- **Mailing address phone:** (757) 679-0654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 3747P1801X | Personal Care Attendant | — | NULL | — |
| 3747P1801X | Personal Care Attendant | — | — | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 05/21/2025
- **Last updated:** 01/27/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30018295920001 | — | VA |
| 01 | — | 30018295920002 | MEDICAIDWIAVER | VA |