Provider Demographics
NPI:1588223259
Name:CANDID HOME CARE VA LLC
Entity Type:Organization
Organization Name:CANDID HOME CARE VA LLC
Other - Org Name:CANDID HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BHUPENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-982-0292
Mailing Address - Street 1:8501 MAYLAND DR STE 103A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4751
Mailing Address - Country:US
Mailing Address - Phone:804-982-0292
Mailing Address - Fax:804-716-4945
Practice Address - Street 1:8501 MAYLAND DR STE 103A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4751
Practice Address - Country:US
Practice Address - Phone:804-982-0292
Practice Address - Fax:804-716-4945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANDID HOME CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588223259Medicaid