Provider Demographics
NPI:1992741060
Name:SENTARA ENTERPRISES
Entity type:Organization
Organization Name:SENTARA ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-553-3000
Mailing Address - Street 1:535 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5176
Mailing Address - Country:US
Mailing Address - Phone:757-553-3000
Mailing Address - Fax:757-382-4957
Practice Address - Street 1:535 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5176
Practice Address - Country:US
Practice Address - Phone:757-553-3000
Practice Address - Fax:757-382-4957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008770344Medicaid
VA9600108Medicaid
VA0091-5216-4Medicaid
442311OtherBC MAJOR MED
VA0049-7268-6Medicaid
VA008703787Medicaid
150608600OtherDEPT OF LABOR
VA16633OtherOPTIMA
VA0049-7268-6Medicaid
VA0049-7268-6Medicaid