Provider Demographics
NPI:1053814483
Name:IMPERIAL HOME HEALTHCARE
Entity Type:Organization
Organization Name:IMPERIAL HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYNESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-578-4720
Mailing Address - Street 1:6040 CAMELLIA DR APT A
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2298
Mailing Address - Country:US
Mailing Address - Phone:202-578-4720
Mailing Address - Fax:757-257-5993
Practice Address - Street 1:6040 CAMELLIA DR APT A
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2298
Practice Address - Country:US
Practice Address - Phone:202-578-4720
Practice Address - Fax:757-257-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid