Provider Demographics
NPI:1215234786
Name:IMMANUAL CARE
Entity type:Organization
Organization Name:IMMANUAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MHA
Authorized Official - Phone:757-547-8400
Mailing Address - Street 1:870 GREENBRIER CIRCLE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2641
Mailing Address - Country:US
Mailing Address - Phone:757-547-8400
Mailing Address - Fax:757-548-7766
Practice Address - Street 1:870 GREENBRIER CIRCLE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2641
Practice Address - Country:US
Practice Address - Phone:757-547-8400
Practice Address - Fax:757-548-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087707607Medicaid
VA0102181010Medicaid
VA0087023492Medicaid