Provider Demographics
NPI:1215109756
Name:SAPPHIRE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:SAPPHIRE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-862-2583
Mailing Address - Street 1:612 S SYCAMORE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5828
Mailing Address - Country:US
Mailing Address - Phone:804-862-2583
Mailing Address - Fax:804-862-2536
Practice Address - Street 1:612 S SYCAMORE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5828
Practice Address - Country:US
Practice Address - Phone:804-862-2583
Practice Address - Fax:804-862-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-08479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0151626436Medicaid
VA0151870422Medicaid