Provider Demographics
NPI:1043961576
Name:HOMEBRIDGE HEALTH CARE CO
Entity type:Organization
Organization Name:HOMEBRIDGE HEALTH CARE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-235-2395
Mailing Address - Street 1:505 CUMBERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707
Mailing Address - Country:US
Mailing Address - Phone:757-235-2395
Mailing Address - Fax:
Practice Address - Street 1:505 CUMBERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-235-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health