Organization
IMMACULATE CARE SERVICES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINNIE R SAVAGE (OWNER)
(757) 335-2404
Entity
Organization
Contact information
Practice address
5935 KNIGHTSBRIDGE WAY, PORTSMOUTH, VA 23703-5506
(757) 335-2404
Mailing address
5935 KNIGHTSBRIDGE WAY, PORTSMOUTH, VA 23703-5506
(757) 335-2404
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A24698259
—
VA
Enumeration date
09/19/2018
Last updated
09/19/2018
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