Provider Demographics
NPI:1376074575
Name:ONE CARE VA INC
Entity Type:Organization
Organization Name:ONE CARE VA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATUTU
Authorized Official - Middle Name:
Authorized Official - Last Name:NYABANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-506-9577
Mailing Address - Street 1:8400 BUSTLETON AVE
Mailing Address - Street 2:307
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1918
Mailing Address - Country:US
Mailing Address - Phone:240-506-9577
Mailing Address - Fax:
Practice Address - Street 1:4601 FAIRFAX DR
Practice Address - Street 2:1200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1500
Practice Address - Country:US
Practice Address - Phone:240-506-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE CARE HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health