Provider Demographics
NPI:1598070880
Name:EMMANUEL HOME CARE AGENCY
Entity Type:Organization
Organization Name:EMMANUEL HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-660-6950
Mailing Address - Street 1:6911 RICHMOND HWY
Mailing Address - Street 2:SUITE 245
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1842
Mailing Address - Country:US
Mailing Address - Phone:703-660-6950
Mailing Address - Fax:
Practice Address - Street 1:6911 RICHMOND HWY
Practice Address - Street 2:SUITE 245
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1842
Practice Address - Country:US
Practice Address - Phone:703-660-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-12677225100000X, 235Z00000X, 251B00000X
VAHC0-12677225X00000X
VAHCO-11677251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366742207Medicare PIN