Provider Demographics
NPI:1992745343
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:L
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 1:426 MCARTHUR DR STE B
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4577
Practice Address - Country:US
Practice Address - Phone:252-337-9320
Practice Address - Fax:252-331-1892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1071251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600658Medicaid
NC77-01485Medicaid
NC34-17202Medicaid
NC6600658Medicaid