Provider Demographics
NPI:1376058891
Name:AA&G HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AA&G HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERTATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELENE
Authorized Official - Middle Name:MCCOY
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-397-0008
Mailing Address - Street 1:4410 W NORFOLK RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2360
Mailing Address - Country:US
Mailing Address - Phone:757-397-0008
Mailing Address - Fax:757-397-1003
Practice Address - Street 1:3215 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3202
Practice Address - Country:US
Practice Address - Phone:757-397-0008
Practice Address - Fax:757-397-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-181604374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0256415669Medicaid