# JEWISH FAMILY SERVICE OF TIDEWATER, INCORPORATED

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

## Provider details

- **NPI number:** 1790791176
- **Authorized official:** LISA DENISE BENJAMIN CPA (CFO)
- **Authorized official phone:** (757) 321-2247

## Contact information

- **Practice address:** 5000 CORPORATE WOODS DR, SUITE 400, VIRGINIA BEACH, VA 23462-4429
- **Practice address phone:** (757) 321-2244
- **Practice address fax:** (757) 321-2260
- **Mailing address:** 5000 CORPORATE WOODS DR, SUITE 400, VIRGINIA BEACH, VA 23462-4429
- **Mailing address phone:** (757) 321-2244
- **Mailing address fax:** (757) 321-2260

## Taxonomy

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

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 03/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004974891 | — | VA |
| 05 | — | 008700435 | — | VA |
| 01 | — | 011608 | ANTHEM BLUE CROSS BLUE SH | VA |