Provider Demographics
NPI:1679802581
Name:POTOMAC HOME HEALTHCARE
Entity Type:Organization
Organization Name:POTOMAC HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-378-1060
Mailing Address - Street 1:3931 AVION PARK CT STE C116
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3983
Mailing Address - Country:US
Mailing Address - Phone:703-378-1060
Mailing Address - Fax:571-321-1366
Practice Address - Street 1:3931 AVION PARK CT STE C116
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3983
Practice Address - Country:US
Practice Address - Phone:703-378-1060
Practice Address - Fax:571-321-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-10620251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health