Provider Demographics
NPI:1487646113
Name:COMMONWEALTH HOME HEALTH INC
Entity Type:Organization
Organization Name:COMMONWEALTH HOME HEALTH INC
Other - Org Name:1ST CARE HOME HEALTH SOUTH BOSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURKHOLD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:434-572-1582
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1006
Mailing Address - Country:US
Mailing Address - Phone:434-572-1312
Mailing Address - Fax:434-572-6211
Practice Address - Street 1:425 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3241
Practice Address - Country:US
Practice Address - Phone:434-572-1312
Practice Address - Fax:434-572-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA226503OtherANTHEM
VA4970217Medicaid
VA4970217Medicaid