Provider Demographics
NPI:1306116215
Name:HALEY, CARIEN N (CEO)
Entity type:Individual
Prefix:MISS
First Name:CARIEN
Middle Name:N
Last Name:HALEY
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5200
Mailing Address - Country:US
Mailing Address - Phone:757-934-1400
Mailing Address - Fax:757-934-1404
Practice Address - Street 1:424 MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5200
Practice Address - Country:US
Practice Address - Phone:757-934-1400
Practice Address - Fax:757-934-1404
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-12774251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0164900836Medicaid
VA0155894261Medicaid
VA0155893966Medicaid