Provider Demographics
NPI:1154760916
Name:HOME HEALTH AIDE
Entity type:Organization
Organization Name:HOME HEALTH AIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSING ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:757-722-4504
Mailing Address - Street 1:625 NEWPORT NEWS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3930
Mailing Address - Country:US
Mailing Address - Phone:757-722-4504
Mailing Address - Fax:
Practice Address - Street 1:625 NEWPORT NEWS AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3930
Practice Address - Country:US
Practice Address - Phone:757-722-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401009775311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1401009775OtherCERTIFIED NURSING ASSISTANT