Provider Demographics
NPI:1902295397
Name:1 MASTER HOME HEALTH
Entity Type:Organization
Organization Name:1 MASTER HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-737-1672
Mailing Address - Street 1:3026 TYRE NECK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4500
Mailing Address - Country:US
Mailing Address - Phone:757-484-4464
Mailing Address - Fax:757-484-4494
Practice Address - Street 1:3026 TYRE NECK RD
Practice Address - Street 2:SUITE G
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4500
Practice Address - Country:US
Practice Address - Phone:757-484-4464
Practice Address - Fax:757-484-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-151044251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health