Provider Demographics
NPI:1326729633
Name:ATCAP FIVE STAR IN-HOME SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:ATCAP FIVE STAR IN-HOME SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILOMINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE ADMINISTRATOR
Authorized Official - Phone:703-967-1099
Mailing Address - Street 1:13164 CENTERPOINTE WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5288
Mailing Address - Country:US
Mailing Address - Phone:703-967-1099
Mailing Address - Fax:571-285-4386
Practice Address - Street 1:13164 CENTERPOINTE WAY STE 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5288
Practice Address - Country:US
Practice Address - Phone:703-967-1099
Practice Address - Fax:571-285-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services