DECORUM HEALTH SERVICES (NPI# 1629699913) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629699913 |
| Entity Type | Organization |
| Organization Name | DECORUM HEALTH SERVICES |
| Practice Address |
3615 W Main St Salem VA 24153-1961 |
| Mailing Address |
Po Box 31494 Henrico VA 23294-1494 |
| Practice Telephone | 5403789772 |
| Mailing Telephone | 5403923699 |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2020-04-28 |
| Authorized Official Name | TRACY L ZIKES (AUTHORIZED OFFICIAL PRESIDENT) |
| Authorized Official Telephone | 5403923699 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MEDICAL LICENSE VIRGINIA | 0024172938 | 01 |
| VA | DEA | MZ3658917 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 120 Old Virginia Ave, Rich Creek, VA 241479669 | 5407262328 |
| Street Address |
3615 W MAIN ST |
| City | SALEM |
| State | VA |
| Zip Code | 24153-1961 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710985841 | Richfield Nursing Center | Durable Medical Equipment & Medical Supplies | 3615 W Main St, Salem, VA 24153-1961 | 2005-07-12 |
| 1679131056 | Jessica Lynn Perkins | Nurse Practitioner | 3615 W Main St, Salem, VA 24153-1961 | 2019-05-31 |
| 1770063844 | Richelle Flici | Physical Therapist | 3615 W Main St, Salem, VA 24153-1961 | 2018-08-18 |
| 1508369893 | Geoffrey Gitau Ngugi | Physical Therapy Assistant | 3615 W Main St, Salem, VA 24153-1961 | 2018-03-13 |
| 1295248458 | Cassandra Flinchum | Occupational Therapist | 3615 W Main St, Salem, VA 24153-1961 | 2017-11-09 |
| 1790135283 | Amy M Bonds | Nurse Practitioner | 3615 W Main St, Salem, VA 24153-1961 | 2016-06-15 |
| 1033576392 | Joseph Swinfen | Physical Therapy Assistant | 3615 W Main St, Salem, VA 24153-1961 | 2016-01-18 |
| 1003219122 | Laura Elizabeth Fenno | Physical Therapist | 3615 W Main St, Salem, VA 24153-1961 | 2014-10-02 |
| 1972912863 | Daryl Allder | Occupational Therapy Assistant | 3615 W Main St, Salem, VA 24153 | 2014-08-05 |
| 1053726851 | Jessica Lea Watts | Occupational Therapy Assistant | 3615 W Main St, Salem, VA 24153-1961 | 2014-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669001228 | Paul Mcguire | Student in an Organized Health Care Education/Training Program | 1906 Braeburn Drive Psychiatry Gme, Salem, VA 24153 | 2020-04-06 |
| 1386114965 | Dynamic Medical LLC | Clinical Medical Laboratory | 1201 Texas Street, Salem, VA 24153 | 2018-11-27 |
| 1134607898 | Renew Psychiatry Services | Psychiatry & Neurology | 177 Electric Rd, Salem, VA 24153 | 2018-08-03 |
| 1508304015 | Samantha Getz | Assisted Living Facility | 3706 Knollridge Rd., Salem, VA 24153 | 2017-02-03 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1154729051 | Allison Marie Parry | Physician Assistant | 1336 W Main St., Salem, VA 24153 | 2014-12-09 |
| 1598199457 | Stacy Stanley | Occupational Therapy Assistant | 4812 Moore Rd, Salem, VA 24153 | 2013-08-28 |
| 1366888034 | Dolores Hager | Speech-Language Pathologist | 1851 Harrogate Dr, Salem, VA 24153 | 2013-05-21 |
| 1073850764 | Joel Aaron Nickerson | Specialist/Technologist | 400 Spartan Dr., Salem High School, Salem, VA 24153 | 2013-01-15 |
| 1023387271 | National Diabetic Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 2153 Apperson Drive, Salem, VA 24153 | 2011-12-16 |
| Find all providers in zip 24153 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184648925 | Karen S Williams | Nurse Practitioner | 25 Witch Meadow Rd, Salem, CT 06420-3602 | 2006-07-26 |
| 1255800850 | Peter Woodring | Nurse Practitioner | 610 Hawthorne Ave Se Ste 110, Salem, OR 97301-5378 | 2018-11-13 |
| 1942711783 | Keechia Gean Muse | Nurse Practitioner | 106 Highway 62 W, Salem, AR 72576-8059 | 2017-10-19 |
| 1346610201 | Charity Capuras | Nurse Practitioner | 1793 13th St Se, Salem, OR 97302-2541 | 2015-10-04 |
| 1114033545 | Timothy Wayne Dayton | Nurse Practitioner | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2006-08-21 |
| 1356389753 | Susan Lysaght Hurley | Nurse Practitioner | 81 Highland Ave, North Shore Medical Center--palliative Care, Salem, MA 01970-2714 | 2006-06-04 |
| 1679538946 | Lori Ann Rutherford | Nurse Practitioner | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2006-04-19 |
| 1881659514 | Rosalie Frances Sanchez-motley | Nurse Practitioner | 1970 Roanoke Blvd, Salem, VA 24153-6404 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831706597 | Martha Luz Alejandro-bird | Nurse Practitioner | 120 Kings Way Ste &3300, Williamsburg, VA 23185-2505 | 2020-09-28 |
| 1285240648 | Stephanie Williams Hatch | Nurse Practitioner | 304 Homestead Rd, Franklin, VA 23851-1345 | 2020-09-21 |
| 1346852639 | Britteny Nicole Stone-joel | Nurse Practitioner | 614 Rolfe Street, Hampton, VA 23661 | 2020-08-19 |
| 1093324469 | Grace A Odallo | Nurse Practitioner | 3441 Raytee Dr, Chesapeake, VA 23323-1230 | 2020-07-30 |
| 1558989186 | Olivia Brooke Wright | Nurse Practitioner | 2451 Midtown Ave Apt 1317, Alexandria, VA 22303-1437 | 2020-07-09 |
| 1467070342 | Amanda K Whitley | Nurse Practitioner | 401 Gordon Ave, Bristol, VA 24201-4106 | 2020-07-08 |
| 1194341792 | Tina Fulcher | Nurse Practitioner | 13300 Burley Ridge Ln, Chester, VA 23831-7119 | 2020-06-19 |
| 1366067373 | Luke Balmer | Nurse Practitioner | 3402 Upper Tillman Way, Powhatan, VA 23139-4349 | 2020-06-15 |
| 1174158539 | Monica Kristine Thompson | Nurse Practitioner | 6340 Miller Dr, Alexandria, VA 22315-3512 | 2020-03-05 |
| 1326670100 | Kristyn Dolores Fox | Nurse Practitioner | 830 Kempsville Rd Ste 2b223, Norfolk, VA 23502-3920 | 2020-02-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.