Provider Demographics
NPI:1992327555
Name:PASSIONATE HEARTS HOME HEALTH AGENCY & SERVICES LLC
Entity type:Organization
Organization Name:PASSIONATE HEARTS HOME HEALTH AGENCY & SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:JENELLE
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-4747
Mailing Address - Street 1:1122 SELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23523-2126
Mailing Address - Country:US
Mailing Address - Phone:757-414-4747
Mailing Address - Fax:
Practice Address - Street 1:1122 SELDEN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-2126
Practice Address - Country:US
Practice Address - Phone:757-414-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992327555Medicaid