Provider Demographics
NPI:1104537042
Name:1ST HOME CARE OF VA., INC.
Entity type:Organization
Organization Name:1ST HOME CARE OF VA., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUANNA
Authorized Official - Middle Name:TIMISHA
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-937-5991
Mailing Address - Street 1:600 W 25TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1212
Mailing Address - Country:US
Mailing Address - Phone:757-937-5991
Mailing Address - Fax:757-937-9118
Practice Address - Street 1:600 W 25TH ST STE 6
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1212
Practice Address - Country:US
Practice Address - Phone:757-937-5991
Practice Address - Fax:757-937-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health