Provider Demographics
NPI:1346655701
Name:BOAGEM HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:BOAGEM HEALTHCARE SERVICES INC.
Other - Org Name:PREMIER PLUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:AFARI
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-580-8118
Mailing Address - Street 1:4008 GENESEE PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8306
Mailing Address - Country:US
Mailing Address - Phone:703-580-8118
Mailing Address - Fax:703-580-9308
Practice Address - Street 1:4008 GENESEE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8306
Practice Address - Country:US
Practice Address - Phone:703-580-8118
Practice Address - Fax:703-580-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-14537251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0156853951Medicaid
VA0156854413Medicaid