Provider Demographics
NPI:1710368808
Name:HARBOR HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HARBOR HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDINASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:703-599-4395
Mailing Address - Street 1:2890 EMMA LEE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-7805
Mailing Address - Country:US
Mailing Address - Phone:703-734-6683
Mailing Address - Fax:703-879-7594
Practice Address - Street 1:2890 EMMA LEE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-7805
Practice Address - Country:US
Practice Address - Phone:703-734-6683
Practice Address - Fax:703-879-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO151293251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health