| Divine Health Care, Llc | |
|
2207 Executive Dr Ste B Hampton VA 23666-2478 | |
| (757) 826-1600 | |
| (757) 826-0160 |
| Full Name | Divine Health Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2207 Executive Dr, Hampton, Virginia |
| Authorized Official Name and Position | Debra Foster Chinnery (OWNER) |
| Authorized Official Contact | 7578260514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Health Care, Llc 2207 Executive Dr Ste B Hampton VA 23666-2478 Ph: (757) 826-1600 | Divine Health Care, Llc 2207 Executive Dr Ste B Hampton VA 23666-2478 Ph: (757) 826-1600 |
| NPI Number | 1053659714 |
|---|---|
| Provider Enumeration Date | 01/30/2013 |
| Last Update Date | 02/13/2017 |
| Medicare PECOS PAC ID | 7618111667 |
|---|---|
| Medicare Enrollment ID | O20130913000392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053659714 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0017000454 (Virginia) | Primary |
| Provider Name | Debra Chinnery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225127582 PECOS PAC ID: 6305903600 Enrollment ID: I20090331000198 |
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