Organization
D-VINE GRACE HOME HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKY CHARLES (CEO/OWNER)
(757) 673-4476
Entity
Organization
Contact information
Practice address
114 CHOWAN DR, SUITE A, PORTSMOUTH, VA 23701-2452
(757) 488-1102
(757) 488-1107
Mailing address
114 CHOWAN DR, SUITE A, PORTSMOUTH, VA 23701-2452
(757) 488-1102
(757) 488-1107
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
151264
VA
251E00000X
Home Health Agency
41999
VA
251E00000X
Home Health Agency
Primary
HCO-171264
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2015086685
—
VA
Enumeration date
02/11/2015
Last updated
08/10/2016
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