Provider Demographics
NPI:1396392759
Name:COUNTRYCARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:COUNTRYCARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-621-3187
Mailing Address - Street 1:6269 LEESBURG PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2103
Mailing Address - Country:US
Mailing Address - Phone:703-621-3187
Mailing Address - Fax:703-842-1194
Practice Address - Street 1:6269 LEESBURG PIKE STE 105
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2103
Practice Address - Country:US
Practice Address - Phone:703-621-3187
Practice Address - Fax:703-842-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty