Provider Demographics
NPI:1316258833
Name:VIRGINIA HEALTHCARE SERVICES OF NORFOLK LLC
Entity type:Organization
Organization Name:VIRGINIA HEALTHCARE SERVICES OF NORFOLK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-626-5466
Mailing Address - Street 1:124 S. LYNNHAVEN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7419
Mailing Address - Country:US
Mailing Address - Phone:757-233-7088
Mailing Address - Fax:757-233-7224
Practice Address - Street 1:124 S. LYNNHAVEN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7419
Practice Address - Country:US
Practice Address - Phone:757-233-7088
Practice Address - Fax:757-233-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
VAHCO-11716251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316258833Medicaid
VA1316258833Medicaid
VA497672Medicare UPIN