Provider Demographics
NPI:1669022158
Name:ULTIMATE SENIOR CARE
Entity Type:Organization
Organization Name:ULTIMATE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMISSION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:KARIM
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-575-3555
Mailing Address - Street 1:12801 DARBY BROOK CT STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2497
Mailing Address - Country:US
Mailing Address - Phone:571-575-3555
Mailing Address - Fax:
Practice Address - Street 1:12801 DARBY BROOK CT STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2497
Practice Address - Country:US
Practice Address - Phone:571-575-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health