Provider Demographics
NPI:1346510286
Name:NORTHERN VIRGINA HOME CARE LLC
Entity Type:Organization
Organization Name:NORTHERN VIRGINA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:757-553-3109
Mailing Address - Street 1:601 S CARLIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1044
Mailing Address - Country:US
Mailing Address - Phone:703-717-7928
Mailing Address - Fax:
Practice Address - Street 1:601 S CARLIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1044
Practice Address - Country:US
Practice Address - Phone:703-717-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO 12804251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO12804OtherHOME CARE LICENSE
VAHCO12804OtherHOME CARE LICENSE