Provider Demographics
NPI:1518398304
Name:BORDEAUX LLC
Entity Type:Organization
Organization Name:BORDEAUX LLC
Other - Org Name:COLONIAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-659-9900
Mailing Address - Street 1:300 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8903
Mailing Address - Country:US
Mailing Address - Phone:540-659-9900
Mailing Address - Fax:540-659-9902
Practice Address - Street 1:300 GARRISONVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8903
Practice Address - Country:US
Practice Address - Phone:540-659-9900
Practice Address - Fax:540-659-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO14958251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0170460551Medicaid
VA0170460809Medicaid