Provider Demographics
NPI:1407564743
Name:AVA HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:AVA HOMECARE AGENCY LLC
Other - Org Name:AVA HOMECARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-495-3998
Mailing Address - Street 1:13383 LAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5519
Mailing Address - Country:US
Mailing Address - Phone:703-495-3998
Mailing Address - Fax:703-289-0401
Practice Address - Street 1:13383 LAUNDERS ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5519
Practice Address - Country:US
Practice Address - Phone:703-495-3998
Practice Address - Fax:703-289-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care