Provider Demographics
NPI:1447738430
Name:AFFECTION HOME HEALTH CARE
Entity Type:Organization
Organization Name:AFFECTION HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHOSINA
Authorized Official - Middle Name:JANNAT
Authorized Official - Last Name:RIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-306-9833
Mailing Address - Street 1:5901 FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2450
Mailing Address - Country:US
Mailing Address - Phone:571-306-9833
Mailing Address - Fax:
Practice Address - Street 1:5901 FLANDERS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2450
Practice Address - Country:US
Practice Address - Phone:571-306-9833
Practice Address - Fax:571-730-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-191903251E00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447738430Medicaid