Provider Demographics
NPI:1578704185
Name:AUTHENTIC HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:AUTHENTIC HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUNAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-597-1378
Mailing Address - Street 1:PO BOX 4752
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-4752
Mailing Address - Country:US
Mailing Address - Phone:703-597-1378
Mailing Address - Fax:703-651-5483
Practice Address - Street 1:8471 IVY GLEN CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4632
Practice Address - Country:US
Practice Address - Phone:703-597-1378
Practice Address - Fax:703-651-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102614655Medicaid