Provider Demographics
NPI:1275022295
Name:CENTRE HOME CARE LLC
Entity Type:Organization
Organization Name:CENTRE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:U
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-342-7827
Mailing Address - Street 1:6601 LITTLE RIVER TPKE STE 240
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 LITTLE RIVER TPKE STE 240
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1316
Practice Address - Country:US
Practice Address - Phone:571-333-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-181187251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health