Provider Demographics
NPI:1376738211
Name:CROWN HOME CARE, INC.
Entity Type:Organization
Organization Name:CROWN HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRAHIM
Authorized Official - Middle Name:GELLE
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-817-1555
Mailing Address - Street 1:14159 MARIAH CT STE 800
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2106
Mailing Address - Country:US
Mailing Address - Phone:703-817-1555
Mailing Address - Fax:703-817-1554
Practice Address - Street 1:14159 MARIAH CT STE 800
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2106
Practice Address - Country:US
Practice Address - Phone:703-817-1555
Practice Address - Fax:703-817-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO08318251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101782156Medicaid