Organization
PROVIDER SOURCE HOME HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENA DICKENS (ADMINISTRATOR)
(757) 324-2979
Entity
Organization
Contact information
Practice address
2211 PRETTY LAKE AVE UNIT 403, NORFOLK, VA 23518-1047
(757) 324-2979
(757) 257-4575
Mailing address
2211 PRETTY LAKE AVE UNIT 403, NORFOLK, VA 23518-1047
(757) 324-2979
(757) 257-4575
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/05/2021
Last updated
03/05/2021
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