Provider Demographics
NPI:1962235226
Name:REGINA'S HOMECARE LLC
Entity type:Organization
Organization Name:REGINA'S HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNTLEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-359-4508
Mailing Address - Street 1:3110 CHALFIN AVENUE
Mailing Address - Street 2:A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513
Mailing Address - Country:US
Mailing Address - Phone:757-359-4508
Mailing Address - Fax:
Practice Address - Street 1:913 FIRST COLONIAL RD STE 204G
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3198
Practice Address - Country:US
Practice Address - Phone:757-359-4508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty