Provider Demographics
NPI:1972850816
Name:GILES HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GILES HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAVENNA
Authorized Official - Middle Name:CINDY
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-515-4609
Mailing Address - Street 1:4433 GODWIN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8483
Mailing Address - Country:US
Mailing Address - Phone:757-255-9554
Mailing Address - Fax:757-255-9556
Practice Address - Street 1:4433 GODWIN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8009
Practice Address - Country:US
Practice Address - Phone:757-255-9554
Practice Address - Fax:757-255-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health