# PROVIDER SOURCE HOME HEALTH CARE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1396330890
- **Authorized official:** KENA DICKENS (ADMINISTRATOR)
- **Authorized official phone:** (757) 324-2979

## Contact information

- **Practice address:** 2211 PRETTY LAKE AVE UNIT 403, NORFOLK, VA 23518-1047
- **Practice address phone:** (757) 324-2979
- **Practice address fax:** (757) 257-4575
- **Mailing address:** 2211 PRETTY LAKE AVE UNIT 403, NORFOLK, VA 23518-1047
- **Mailing address phone:** (757) 324-2979
- **Mailing address fax:** (757) 257-4575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/05/2021
- **Last updated:** 03/05/2021