Provider Demographics
NPI:1063827996
Name:ULTICARE HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:ULTICARE HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NYEREYEMHUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-332-5066
Mailing Address - Street 1:9215 GLEN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-3109
Mailing Address - Country:US
Mailing Address - Phone:703-753-5815
Mailing Address - Fax:
Practice Address - Street 1:9215 GLEN MEADOW LN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-3109
Practice Address - Country:US
Practice Address - Phone:703-753-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health