1013989276 NPI number — HOLIDAY HOUSE OF PORTSMOUTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013989276 NPI number — HOLIDAY HOUSE OF PORTSMOUTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLIDAY HOUSE OF PORTSMOUTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013989276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 COUNTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23707-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-397-6352
Provider Business Mailing Address Fax Number:
757-399-2356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 COUNTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23707-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-397-6352
Provider Business Practice Location Address Fax Number:
757-399-2356
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEGILL
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
BATSON
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
757-397-6352

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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