Provider Demographics
NPI:1205388584
Name:AA ALTIMATE HOME CARE INC.
Entity Type:Organization
Organization Name:AA ALTIMATE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-380-6809
Mailing Address - Street 1:6560 BACKLICK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2806
Mailing Address - Country:US
Mailing Address - Phone:703-643-4066
Mailing Address - Fax:571-316-1654
Practice Address - Street 1:6560 BACKLICK RD STE 206
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2806
Practice Address - Country:US
Practice Address - Phone:703-643-4066
Practice Address - Fax:571-316-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVIRGINIAMedicaid