Provider Demographics
NPI:1164293700
Name:ACCESS CARE GROUP HOME LLC
Entity Type:Organization
Organization Name:ACCESS CARE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MA. ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECENA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:571-275-4329
Mailing Address - Street 1:910 W REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-5117
Mailing Address - Country:US
Mailing Address - Phone:571-275-4329
Mailing Address - Fax:
Practice Address - Street 1:914 W REDWOOD RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5117
Practice Address - Country:US
Practice Address - Phone:571-275-4329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child