Provider Demographics
NPI:1619118528
Name:FIVE STAR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:FIVE STAR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-662-7500
Mailing Address - Street 1:14900 BOGLE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1799
Mailing Address - Country:US
Mailing Address - Phone:703-662-7500
Mailing Address - Fax:703-661-6397
Practice Address - Street 1:14900 BOGLE DR STE 310
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1799
Practice Address - Country:US
Practice Address - Phone:703-662-7500
Practice Address - Fax:703-661-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAJCAHO 518135251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497678Medicare PIN