Provider Demographics
NPI:1235181264
Name:ADVANCE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ADVANCE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:XANTHAKYS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:571-246-3622
Mailing Address - Street 1:6 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 130-A
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6146
Mailing Address - Country:US
Mailing Address - Phone:571-246-3622
Mailing Address - Fax:703-421-1461
Practice Address - Street 1:6 PIDGEON HILL DR
Practice Address - Street 2:SUITE 130-A
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6146
Practice Address - Country:US
Practice Address - Phone:571-246-3622
Practice Address - Fax:703-421-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-353251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-353OtherHOME CARE LICENSE NUMBER
VAHCO-353OtherHOME CARE LICENSE NUMBER