Provider Demographics
NPI:1700028263
Name:HEBRON HOMES LLC
Entity Type:Organization
Organization Name:HEBRON HOMES LLC
Other - Org Name:HEBRON HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:OKYERE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-293-6961
Mailing Address - Street 1:2114 ANGUS RD
Mailing Address - Street 2:SUITE 237
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2768
Mailing Address - Country:US
Mailing Address - Phone:434-293-6961
Mailing Address - Fax:540-301-1800
Practice Address - Street 1:2114 ANGUS RD
Practice Address - Street 2:SUITE 237
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2768
Practice Address - Country:US
Practice Address - Phone:434-293-6961
Practice Address - Fax:540-301-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09557251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-09557OtherVIRGINIA DEPARTMENT OF HEALTH, OFFICE OF LICENSURE AND CERTIFICATION