Provider Demographics
NPI:1629326533
Name:HOME CARE ASSISTANCE OF VIRGINIA LLC
Entity Type:Organization
Organization Name:HOME CARE ASSISTANCE OF VIRGINIA LLC
Other - Org Name:HOME CARE ASSISTANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-356-4333
Mailing Address - Street 1:6723 CURRAN ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3804
Mailing Address - Country:US
Mailing Address - Phone:703-356-4333
Mailing Address - Fax:
Practice Address - Street 1:6723 CURRAN ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3804
Practice Address - Country:US
Practice Address - Phone:703-356-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-13558253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-13558OtherVIRGINIA HOME CARE ORGANIZATION