Provider Demographics
NPI:1629585674
Name:CUADRO HOME CARE INCORPORATED
Entity Type:Organization
Organization Name:CUADRO HOME CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOPHACHAN
Authorized Official - Last Name:TEP-CUADRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:757-560-6466
Mailing Address - Street 1:14192 CHAPMANS LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-9718
Mailing Address - Country:US
Mailing Address - Phone:757-560-6466
Mailing Address - Fax:
Practice Address - Street 1:14192 CHAPMANS LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314
Practice Address - Country:US
Practice Address - Phone:757-560-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care