Provider Demographics
NPI:1164485975
Name:IMPERIAL HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:IMPERIAL HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONGANTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-237-1388
Mailing Address - Street 1:916 W BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3135
Mailing Address - Country:US
Mailing Address - Phone:703-237-1388
Mailing Address - Fax:703-237-3189
Practice Address - Street 1:916 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3135
Practice Address - Country:US
Practice Address - Phone:703-237-1388
Practice Address - Fax:703-237-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-3493140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric