Provider Demographics
NPI:1437648326
Name:SHAMROCK KEY, LLC
Entity Type:Organization
Organization Name:SHAMROCK KEY, LLC
Other - Org Name:AMADA SENIOR CARE OF SOUTHERN FAIRFAX COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:REINARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:571-297-7499
Mailing Address - Street 1:5600 GENERAL WASHINGTON DR STE B202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2415
Mailing Address - Country:US
Mailing Address - Phone:571-297-7499
Mailing Address - Fax:
Practice Address - Street 1:5600 GENERAL WASHINGTON DR STE B202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2415
Practice Address - Country:US
Practice Address - Phone:571-297-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
VA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty