Organization
NO PLACE LIKE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELENE HAIRSTON STEPHENSON RN (OWNER)
(276) 421-2156
Entity
Organization
Contact information
Practice address
1713 SUNSET DR, BASSETT, VA 24055-4834
(276) 421-2156
(276) 421-2157
Mailing address
1713 SUNSET DR, BASSETT, VA 24055-4834
(276) 421-2156
(276) 421-2157
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0162071366
—
VA
Enumeration date
08/13/2015
Last updated
08/13/2015
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