Provider Demographics
NPI:1568139871
Name:HOMEBASE HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HOMEBASE HOME HEALTHCARE, LLC
Other - Org Name:HOMEBASE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:703-718-6455
Mailing Address - Street 1:7371 ATLAS WALK WAY STE 161
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2992
Mailing Address - Country:US
Mailing Address - Phone:703-718-6455
Mailing Address - Fax:
Practice Address - Street 1:10432 BALLS FORD RD STE 300
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2517
Practice Address - Country:US
Practice Address - Phone:703-718-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No253Z00000XAgenciesIn Home Supportive Care
No333300000XSuppliersEmergency Response System Companies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child