Provider Demographics
NPI:1215413661
Name:1ST ACCESS HOME CARE INCORPORATED
Entity Type:Organization
Organization Name:1ST ACCESS HOME CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYENSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-501-1993
Mailing Address - Street 1:1001 SOMMERSWORTH LN APT 1822
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1156
Mailing Address - Country:US
Mailing Address - Phone:571-501-1993
Mailing Address - Fax:
Practice Address - Street 1:6600 FIELDTAN TRL
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1630
Practice Address - Country:US
Practice Address - Phone:571-501-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health