Provider Demographics
NPI:1558132753
Name:BOM CARE INC
Entity Type:Organization
Organization Name:BOM CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-200-9150
Mailing Address - Street 1:10387 MAIN ST # LL6
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2453
Mailing Address - Country:US
Mailing Address - Phone:571-398-1229
Mailing Address - Fax:
Practice Address - Street 1:10387 MAIN ST # LL6
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2453
Practice Address - Country:US
Practice Address - Phone:571-398-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care